Blood Pressure Mediates the Association Between Visceral-to-Subcutaneous Fat Ratio and Arterial Stiffness in Patients With Type 2 Diabetes.

BACKGROUND

Emerging evidence links visceral adiposity to arterial stiffness. However, the pathways underlying the association between an elevated visceral-to-subcutaneous fat ratio (V/S ratio) and brachial-ankle pulse wave velocity (baPWV), especially the mediating role of blood pressure, remain unclear in patients with diabetes. We aimed to assess the mediating effects of systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the relationship between the V/S ratio and arterial stiffness in individuals with Type 2 diabetes mellitus (T2DM).

METHODS

In this cross-sectional study, 1086 adults with T2DM were enrolled between 2022 and 2024. The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed using a dual bioelectrical impedance analyzer, and the V/S ratio was calculated as VFA/SFA. Arterial stiffness was evaluated via baPWV. Associations between V/S ratio, blood pressure, and baPWV were examined using multivariable regression. The potential mediating role of blood pressure was further investigated.

RESULTS

After adjusting for confounders, a one-unit increase in the V/S ratio was statistically significantly associated with a 131.81 cm/s higher baPWV (95% CI: 25.67-237.96). The V/S ratio is positively associated with SBP (β = 7.76, 95% CI: 1.10-14.42) and DBP (β = 3.93, 95% CI: 0.31-7.56). Mediation analysis revealed that SBP and DBP accounted for 41.8% and 33.2% of the effect of the V/S ratio on baPWV, respectively.

CONCLUSIONS

An elevated V/S ratio is significantly associated with increased arterial stiffness among patients with T2DM. Moreover, this association may be partially mediated by SBP or DBP.