Background— Although several lines of evidence point to an atherogenic role of central fat mass (CFM), few data are available to address the specific role played by peripheral fat mass (PFM).

Methods and Results— This study was a cross-sectional analysis of 1356 women aged 60 to 85 years. Study variables were physical measures, CFM and PFM measured by DEXA, aortic calcification (AC) graded on lateral radiographs, lipid and glucose metabolites, blood pressure, and information on lifestyle factors and coronary disease. Peripheral fat mass showed independent negative correlation with both atherogenic metabolic risk factors and AC (P<0.001). The most severe insulin resistance-dyslipidemic syndrome and AC (score 5.10±0.76) was found in women with high central fat percentage (CF%, 21.7±0.2%) and low peripheral fat percentage (PF%, 18.3±0.2%, n=48). The least severe AC (score 2.45±0.31) was found in obese women with high CF% (21.6±0.1%) and high PF% (27.3±0.14%, n=112). The insulin resistance-dyslipidemic syndrome was also less severe compared with those with the same CF% but low PF%. The most favorable metabolic profile characterized women with low CF% (11.56±0.16%) and high PF% (26.86±0.33%, n=44). In women with a history of myocardial infarct (18.41±0.55%, n=45), CF% was significantly higher compared with women with no manifest coronary disease (16.48±0.12%, n=1210) without differences in PF%.

Conclusions— In elderly women, localization of fat mass is apparently more important for atherosclerosis than obesity per se; although CFM is associated with atherogenic tendencies, PFM seems to exhibit an independent dominant antiatherogenic effect.