Greater pericardial and visceral adiposity increase risk of hospitalization or death from SARS-CoV-2 infection in community dwelling adults: A C4R Study

ImportanceHigher body mass index (BMI) increases risk of respiratory failure and death from SARS-CoV-2 infection. BMI is imprecise and fails to account for adipose tissue distribution. ObjectiveTo determine whether pericardial adipose tissue (PAT), abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), or hepatic adipose deposition on pre-pandemic computed tomography (CT) scans associate with increased risk of hospitalization or death from SARS-CoV-2. DesignThe Collaborative Cohort of Cohorts for COVID-19 Research (C4R) ascertained SARS-CoV-2 outcomes among participants from 14 US-based cohort studies. This analysis includes participants enrolled in the Jackson Heart, CARDIA, MESA, and Framingham Heart studies. ParticipantsC4R attempted to enroll all cohort participants who were alive on March 1, 2020 and had not withdrawn consent for cohort participation. ExposuresAdipose depot size measured on research CT scans performed between 2000 and 2011. OutcomeTime from March 1, 2020 to hospitalization or death from SARS-CoV-2 infection ascertained by self- report or active surveillance and confirmed when available, by protocolized record review. ResultsThere were 8412 participants with at least one CT adipose measure, among whom 184 events occurred over a median (interquartile range) of 547 (338-609) days. Participants were 57% female with median (SD) age of 69.1 (10.4) years. In adjusted models, both higher PAT (per doubling in PAT volume, HR 1.62, 95% CI 1.25-2.09) and higher VAT (per 1-standard deviation, HR 1.41, 95% CI 1.20-1.67) were associated with greater hazards of hospitalization or death from SARS-CoV-2. Associations remained after adjustment for BMI, diabetes, cardiovascular disease, and hypertension. SAT was associated with hospitalization or death from SARS-CoV-2 but not after adjustment for BMI, diabetes, cardiovascular disease or hypertension. Hepatic adipose deposition was not associated with hospitalization or death. Associations did not vary by sex, age, race, cohort, smoking status, diabetes, or BMI. Conclusions and RelevanceGreater CT-measured pericardial and abdominal visceral adipose tissue were associated with increased hazards of hospitalization or death from SARS-CoV-2 independent of BMI or clinical cardiometabolic comorbidities. Further research should investigate use of CT adipose measures to quantify risk of severe disease from viral infections and to investigate mechanisms linking adiposity to lung injury. Key Points QuestionIs ectopic adipose deposition measured on pre-pandemic CT scan associated with risk of respiratory failure from SARS-CoV-2? FindingsIn this retrospective cohort study of 8812 participants enrolled in 4 large cohort studies pre- pandemic, greater pericardial and abdominal visceral adipose tissue were associated with increased risk of severe SARS-CoV-2 infection independent of body mass index, diabetes, hypertension, and cardiovascular disease. MeaningPericardial and abdominal visceral adipose tissue are associated with increased risk of hospitalization or death from SARS-CoV2 independent of existing measures of obesity; use of these measures could improve our risk assessments.