Pericardial and Abdominal Visceral Adiposity Are Associated With Increased Risk of Hospitalization or Death From SARS-CoV-2 Infection: A Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study

Background Obesity increases risk of death from SARS-CoV-2 infection. Excess ectopic fat may increase this risk through inflammation, hypercoagulability, and immune dysfunction. We hypothesized that greater pericardial (PAT) and visceral adipose tissue (VAT) would associate with higher risk of hospitalization or death from SARS-CoV-2. Methods C4R collected SARS-CoV-2 outcomes from US-based cohort studies. These were linked to chest and abdominal CT scans obtained from Jackson Heart (2007-2010) and CARDIA (2010-2011) studies. We standardized PAT across cohorts and VAT within each cohort to account for differences in VAT measurement protocols. Our outcome was COVID-related hospitalization or death from March 2020 to February 2023 assessed via questionnaires, serosurvey, and record review. Logistic regression models were adjusted for age, sex, race/ethnicity, education, smoking status, and cohort. We adjusted for body mass index (BMI) at COVID assessment in secondary models. Results We included 3002 subjects with mean (SD) age of 62 (6) years, of whom 62% were women, 41% White, 59% Black, 59% never smokers, and 13% current smokers. Sixty-one subjects (2%) had SARS-CoV-2 related hospitalization or death. Every 1-standard deviation (SD) increment in PAT volume was associated with 79% higher odds of hospitalization or death (95%CI 1.38-2.33, Fig A); the estimate was similar after adjusting for BMI (OR 1.71, 95%CI 1.27-2.31). Abdominal VAT was associated with higher odds of hospitalization or death (OR 1.47 per 1 SD, 95%CI 1.20-1.81, Fig B), even after adjustment for BMI (OR 1.35, 95%CI 1.05-1.72). Conclusion Greater pericardial or visceral adiposity measured 10-15 years prior to SARS-CoV-2 emergence, was associated with higher odds of hospitalization or death from SARS-CoV-2 independent of BMI. Lowering PAT and VAT may have collateral benefit for those who develop SARS-CoV-2 infection. Further study of the role of visceral adipose in viral infection is needed.