ABC | Volume 112, Nº3, March 2019

Original Article Eickemberg et al Abdominal adiposity and C-IMT in the ELSA-Brasil Arq Bras Cardiol. 2019; 112(3):220-227 Table 1 – Baseline characteristics, according to the carotid intima-media thickness and gender. ELSA-Brazil, 2008-2010 Male Female CIMT < P75 CIMT ≥ P75 CIMT < P75 CIMT ≥ P75 n = 2,779 n = 958 n = 3,503 n = 1,209 Age, median (IQR) 48 (43-54) 57 (51-63) 47 (43-53) 57 (51-62) Ethnicity/skin color, n (%) White 1,562 (56.2) 545 (56.8) 2,010 (57.3) 705 (58.3) Brown 836 (30.0) 266 (27.7) 883 (25.2) 306 (25.3) Black 381 (13.7) 147 (15.3) 610 (17.4) 198 (16.3) Level of schooling, n (%) Complete College/University 1,352 (48.6) 420 (43.8) 1,976 (56.4) 613 (50.7) Complete High School 1,049 (37.7) 310 (32.3) 1,292 (36.8) 413 (34.1) Incomplete + complete Elementary School 378 (13.6) 228 (23.8) 235 (6.7) 183 (15.1) Smoking status, n (%) Never smoked 1,588 (57.1) 366 (38.2) 2,284 (65.2) 695 (57.4) Former smoker 811 (29.1) 404 (42.2) 803 (22.9) 334 (27.6) Current smoker 380 (13.6) 187 (19.5) 416 (11.8) 180 (14.8) HDL-cholesterol, median (IQR) 49 (43-57) 49 (43-57) 60 (52-71) 59 (51-70) LDL-cholesterol, median (IQR) 130 (110-152) 138.5 (117-161) 127 (106-149) 140 (119-164) Arterial hypertension, n (%) 709 (25.5) 499 (52.1) 644 (18.3) 540 (44.7) Mean BMI (IQR) 26.0 (23.6-28.5) 27.2 (24.6-29.9) 25.3 (22.7-29.5) 27.3 (24.1-30.4) Abdominal adiposity, median (IQR) Waist circumference 92.3 (85.5-99.4) 96.6 (89.4-104.1) 83.2 (76.5-91.4) 88.9 (81-97.3) Waist-to-hip ratio 0.93 (0.88-0.97) 0.96 (0.92-1.00) 0.82 (0.78-0.87) 0.86 (0.81-0.91) Conicity index 1.26 (1.21-1.30) 1.29 (1.24-1.34) 1.19 (1.14-1.25) 1.23 (1.18-1.29) Lipid accumulation product 38.8 (22.1-65.3) 51.2 (30.4-82.2) 26.48 (15.3-44.4) 39.9 (23.4-63.3) Visceral adiposity index 2.41 (1.47-3.95) 2.91 (1.74-4.66) 1.62 (1.06-2.61) 2.15 (1.37-3.43) Abdominal adiposity, n (%) Waist circumference 1,599 (57.5) 690 (72.0) 1,939 (55.3) 884 (73.1) Waist-to-hip ratio 1,628 (58.5) 751 (78.3) 1,744 (49.7) 847 (70.0) Conicity index 1,740 (62.6) 738 (77.0) 1,657 (47.3) 798 (66.0) Lipid accumulation product 1,670 (60.0) 715 (74.6) 1,834 (52.3) 865 (71.5) Visceral adiposity index 1,774 (63.8) 708 (73.9) 1,733 (49.4) 799 (66.0) The sum of observations may differ in some variables due to data loss; CIMT: carotid intima-media thickness; P75: 75th percentile; IQR: interquartile range; n (%): number of observations (frequency); BMI: body mass index. Few studies have compared different indicators of adiposity with CIMT, and the present study is the first one that separately investigated the contribution of different indicators of abdominal adiposity. Previous studies also carried out with ELSA-Brazil data also evaluated the association between traditional risk factors and CIMT. 25,26 WC, WHR, waist-to-height ratio (WHtR) and neck circumference (NC) were included in the analysis. The latter indicator had the strongest association with CIMT. The authors suggest that the local effect produced by neck fat acts directly on the carotid arteries. 25,26 Our study did not include neck circumference; however, the measures used in the study are relatively simple and reflect important information about the risk of developing cardiovascular diseases, at individual and population levels. 27 Most studies that evaluated the association between abdominal adiposity and CIMT used visceral fat measured by imaging tests. In these studies, visceral fat was strongly associated with CIMT, 28,29 but the comparison with these findings is limited by the different methods used to identify abdominal and visceral fat. The association between abdominal adiposity and subclinical atherosclerosis is possibly related to the visceral component of abdominal fat. The indicators evaluated in the present study are 223