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To the Editor:Tanko et al1 observed that peripheral adiposity in elderly women may be associated with a relatively reduced risk of insulin resistance, dyslipidemia, and vascular calcification. They suggested that this benefit reflects an antiatherogenic effect of peripheral fat. However, we believe their findings support the concept that subtly increased glucocorticoid activity may exert dysmetabolic and atherogenic effects. It is well known, for example, that supraphysiologic levels of glucocorticoids, as seen in Cushing syndrome, increase central adiposity at the expense of peripheral adiposity and muscle mass. In recent years, there has been increasing evidence that connects physiologically elevated endogenous glucocorticoid activity with visceral obesity—a phenomenon that may be mediated at the central level …

Can Glucocorticoid Homeostasis Explain the Antiatherogenic Effect of Peripheral Adiposity?