An article written by Dr Edward Leatham, Consultant Cardiologist
For more information about Cardiology 3.0 and how a VAT CT scan can be used to measure your visceral adipose tissue, the leading cause of heart disease and poor metabolic health leading to reduced health and lifespan, see the blog articles or and/or register for the book series out in 2026 https://www.vat-trap.com/
Cardiology 3.0 – A CT scanner is used not only to assess coronary plaque burden/ FAI but also to obtain a cross-sectional image of the abdomen 3 cm above the lower most margin of the lumbar spinal vertebral body. Specialist software is used to ‘window’ the fat tissue in range of -150 to -50 Hounsfield units following image transfer to a Terarecon workstation, where we identify the lining of the peritoneal cavity (thin red line) allowing the partitioning of subcutaneous (in blue) and visceral adipose tissue (VAT, in green). This allows the VAT area of each to be calculated. Adjustments are then made for any green pixels falling within the bowel structures (eg colon in example above).
Table of reference ranges
Our reference range for reporting of VATI (visceral adipose tissue index, which is the VAT in cm2 divided by the square of the height (measured in M).
Examples
Case 1 a male patient with expanded waist where the visceral adipose tissue score is in healthy range- overweight, ‘metabolically healthy’
With a waist of over 100 cm, you might imagine this overweight man would have a terrifically unhealthy VAT. The CT shows most of his adipose is subcutaneous not visceral. His VAT was 88 cm2, which is normal. Although the patient is overweight and advised to lose weight for best health, he is currently ‘metabolically healthy’.
Case 2 Obese male, with hypertension and healthy visceral adipose tissue score
A man with waist of over 123 cm and BMI categorised as obese. The CT shows most of his adipose is subcutaneous not visceral. His VAT area measured 119 cm2 – which is normal for his height. Although obese , he is currently ‘metabolically healthy’.
Case 3 Overweight with healthy visceral adipose tissue score
A man with raised FAI and some middle age spread whose waist measured 111 cm . The CT shows most of his adipose is visceral not subcutaneous. His VAT was 211 cm2 – which is very high, when corrected for his height. This high VAT floods the liver with cytokines and free fatty acids leading to insulin resistance, raised small dense LDL and is metabolically extremely unhealthy.
Case 4 A man with very high FAI score on cardiac CT despite a year of statin therapy
A man with extensive coronary artery disease, raised hsCRP and very raised coronary inflammation (FAI) despite statins who had some ‘middle age spread’ with waist measured 110 cm . The CT shows most of his adipose is visceral not subcutaneous. His VAT was 235 cm2 – which is very high when corrected for his height. He is metabolically extremely unhealthy. Now starting GLP-1 mimetic therapy.
Paired VAT scan can be repeated after GLP-1M intervention.
Case 3 before and after 3 months of ‘VAT-reduction’ therapy’ using lifestyle, weight training and microdose GLP-1 mimetic. Paired CT VAT scans taken using identical CT slice with identical settings 3 cm above the lower margin of L3. The VAT dropped from 211 cm2 to 123 cm2 (into a ‘metabolically healthy’ range), with waist dropping 10 cm and weight falling from 102 Kg to 92 Kg. With skeletal muscle growth this intervention is termed ‘remodelling’ or ‘metabolic reset’.
A man with raised FAI and some middle age spread whose waist measured 111 cm . The CT shows most of his adipose is visceral not subcutaneous. His VAT was 211 cm2 – which is very high, when corrected for his height. This high VAT floods the liver with cytokines and free fatty acids leading to insulin resistance, raised small dense LDL and is metabolically extremely unhealthy.
