Sex differences in the association of vital exhaustion with regional fat deposition and subclinical cardiovascular disease risk

Objective: Vital exhaustion (VE) is more strongly associated with cardiovascular disease (CVD) risk for women than men. This study examined whether sex differences in associations of VE with CVD risk markers are accounted for by unique associations of VE with regional adiposity. Methods: The study enrolled 143 persons (18–55 years) without diagnosed conditions. VE was assessed by the Maastricht questionnaire. CVD indices were measured using the euglycemic-hyperinsulinemia clamp, resting blood pressure, and blood draws. Regional adiposity was measured using computed tomography and 2-D echocardiography. This cross-sectional study employed a path analysis approach, including relevant covariates. Results: Of the cohort, aged 38.7 ± 8.4 years, 65% were men, and 41% were obese. The final model had excellent fit (χ²(36) = 36.5, p =.45; RMSEA = 0.009, CFI = 0.999). For women, but not men, the model indicated paths from VE to: 1) lower insulin sensitivity (B = −0.10, p =.04), and higher total cholesterol to HDL ratio (B = 0.12, p =.09), triglycerides (B = 0.10, p =.08), and C-reactive protein (B = 0.08, p =.09) through visceral adiposity; 2) higher mean arterial pressure (B = 0.14, p =.04), lower insulin sensitivity (B = −0.09, p =.08), and higher C-reactive protein (B = 0.12, p =.07) through subcutaneous adiposity; 3) lower insulin sensitivity (B = −0.07, p =.08) and higher total cholesterol to HDL ratio (B = 0.16, p =.03) through liver adiposity; and 4) higher C-reactive protein (B = 0.08, p =.09) through epicardial adiposity. Conclusion: Results extend prior evidence by showing that the association of VE with CVD risk in women is linked with specific regional adiposity elevation. Further study of adiposity-related mechanisms in women who experience early decline in vitality may inform clinical targets for CVD prevention.