Research Summary

Visceral Fat Better Predicts Cardiovascular Risk Than BMI in People With HIV

Anthony Calabro, MA

Key Highlights

  • Excess visceral abdominal fat (EVAF) was present in 58% of participants across BMI categories.
  • Low BMI with EVAF was linked to the highest cardiovascular risk scores
  • BMI alone missed identifying high-risk individuals.
  • Waist circumference or direct visceral fat measurement may improve risk assessment.

For people with HIV (PWH) receiving long-term antiretroviral therapy (ART), EVAF is common and strongly associated with elevated cardiovascular (CV) risk, independent of BMI. Weight gain and obesity are increasingly prevalent among PWH on ART, raising concern for associated cardiometabolic diseases. BMI, although commonly used to assess risk, does not reliably capture visceral fat distribution, which may be a stronger predictor of adverse outcomes. This study, which was presented at the Conference on Retroviruses and Opportunistic Infections 2025 in San Franciso, CA, aimed to clarify the relationship between BMI, visceral fat, and cardiovascular risk in PWH.

In the Visceral Adiposity Measurement and Observation Study (VAMOS) study, EVAF was detected in 58% of participants, including 43.2% of those with normal BMI and 56.6% of those overweight. Those with low BMI but EVAF had the highest 10-year atherosclerotic cardiovascular disease risk scores, highlighting that BMI alone may underestimate cardiovascular risk in this population.

The VAMOS study enrolled 170 PWH with long-term viral suppression and BMI between 20 and 40 kg/m². Participants underwent fasting labs and abdominal CT scans to quantify visceral adipose tissue (VAT), defining EVAF as VAT ≥130 cm². Cardiovascular risk was assessed using 10-year ASCVD risk scores, and group comparisons were made using Kruskal-Wallis and Dunn tests.

Participants had a median VAT area of 148 cm². Although EVAF prevalence was highest in those with BMI >35 kg/m² (66.7%), it was also common in participants with normal BMI. Cardiovascular risk scores differed significantly across groups stratified by BMI and EVAF (P = .0019). Participants with low BMI and EVAF had significantly higher CV risk scores compared with those with low BMI without EVAF (P = .0039) and high BMI without EVAF (P = .03). Higher insulin resistance, as measured by HOMA-IR, was also observed in low-BMI participants with EVAF (P = 0.02).

“These data highlight the limitations of utilizing BMI alone in assessing CV risk among PWH, particularly given the high CV risk seen in participants with low BMI but high EVAF,” the study authors concluded. “Incorporating tools to assess EVAF, such as waist circumference, could provide critical information in identifying PWH at risk of CVD.”

Reference:
Zogheib M, Koethe J, Lake JE, Mounzer K, Caldji C, Cash B, McGary C. BMI is a poor surrogate for excess visceral adiposity and cardiovascular risk in persons with HIV. Presented at: CROI 2025; March 9-12, 2025; San Francisco, CA. Abstract 830. https://www.croiconference.org/abstract/2873-2025/.