To assess the relationship between body fat distribution and incident lower-extremity arterial disease (LEAD).

We included 155,925 postmenopausal women with anthropometric measures from the Women's Health Initiative who had no known LEAD at recruitment. A subset of 10,894 participants had body composition data quantified by DXA. Incident cases of symptomatic LEAD were ascertained and adjudicated through medical record review.

We identified 1,152 incident cases of LEAD during a median 18.8 years follow-up. After multivariable adjustment and mutual adjustment, waist and hip circumferences were positively and inversely associated with risk of LEAD, respectively (both P-trend < 0.0001). In a subset (n = 22,561) where various cardiometabolic biomarkers were quantified, a similar positive association of waist circumference with risk of LEAD was eliminated after adjustment for diabetes and HOMA of insulin resistance (P-trend = 0.89), whereas hip circumference remained inversely associated with the risk after adjustment for major cardiometabolic traits (P-trend = 0.0031). In the DXA subset, higher trunk fat (P-trend = 0.0081) and higher leg fat (P-trend < 0.0001) were associated with higher and lower risk of LEAD, respectively. Further adjustment for diabetes, dyslipidemia, and blood pressure diminished the association for trunk fat (P-trend = 0.49), yet the inverse association for leg fat persisted (P-trend = 0.0082).

Among U.S. postmenopausal women, a positive association of upper-body fat with risk of LEAD appeared to be attributable to traditional risk factors, especially insulin resistance. Lower-body fat was inversely associated with risk of LEAD beyond known risk factors.

评估身体脂肪分布与下肢动脉疾病 (LEAD) 之间的关系。

我们纳入了 155,925 名绝经后妇女，这些妇女在招募时没有已知的 LEAD。10,894 名参与者的子集具有通过 DXA 量化的身体成分数据。有症状的 LEAD 事件病例通过病历审查确定和裁定。

我们在中位 18.8 年的随访期间确定了 1,152 例 LEAD 事件。经过多变量调整和相互调整后，腰围和臀围分别与 LEAD 风险呈正相关和负相关（均P趋势 < 0.0001）。在对各种心脏代谢生物标志物进行量化的子集 ( n = 22,561) 中，在针对糖尿病和胰岛素抵抗的 HOMA 进行调整后，消除了腰围与 LEAD 风险的类似正相关关系（P趋势 = 0.89），而臀围仍然呈负相关与调整主要心脏代谢特征后的风险相关（P趋势 = 0.0031）。在 DXA 子集中，较高的躯干脂肪 ( P-trend = 0.0081) 和较高的腿部脂肪 ( P -trend < 0.0001) 分别与较高和较低的 LEAD 风险相关。对糖尿病、血脂异常和血压的进一步调整减少了与躯干脂肪的关联（P趋势 = 0.49），但与腿部脂肪的负相关仍然存在（P趋势 = 0.0082）。

在美国绝经后妇女中，上半身脂肪与 LEAD 风险呈正相关似乎可归因于传统风险因素，尤其是胰岛素抵抗。除了已知的风险因素外，下半身脂肪与 LEAD 风险呈负相关。