Abstract
BackgroundExcess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture. Patients with diabetes mellitus (DM) have more VAT than patients without DM, but the extent to which VAT contributes to the characteristics of coronary plaques before and after the development of DM is not fully understood.MethodsWe retrospectively evaluated 456 patients (60% male, age 64 ± 16 years) who were suspected to have cardiovascular disease and underwent 64-slice computed tomography angiography (CTA). Seventy-one (16%) patients had vulnerable plaques (CT density < 50 Hounsfield Units, positive remodeling index > 1.05, and adjacent spotty areas of calcification).ResultsPatients were divided into tertiles according to the VAT area. There were stepwise increases in noncalcified and vulnerable plaques with increasing tertiles of VAT area in patients without DM, but not in patients with DM. Multivariate analysis showed that a larger VAT area was significantly associated with a higher risk of vulnerable plaque in patients without DM (odds ratio 3.17, 95% confidence interval 1.08–9.31, p = 0.04), but not in patients with DM.ConclusionsThe VAT area is associated with the characteristics of coronary plaques on CTA in patients without DM, but not in patients with DM. VAT may be a significant cardiometabolic risk factor that is associated with plaque vulnerability before the development of DM. CTA findings may help to improve risk stratification in such patients.
Highlights
Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture
The body mass index (BMI) has been used to evaluate the impact of obesity on cardiovascular disease, but recent studies have shown that the amount of visceral adipose tissue (VAT) evaluated by the waist-to-hip ratio or computed tomography (CT) findings is more closely associated with cardiovascular events than BMI [2,3]
In patients without diabetes mellitus (DM), the T3 group had a higher proportion of men, more advanced age, higher prevalence of hypertension and use of antihypertensive agents, higher prevalence of dyslipidemia and use of lipid-lowering agents, lower level of HDL-cholesterol, and higher levels of triglycerides, hemoglobin A1c (HbA1c), and high-sensitivity C-reactive protein (hsCRP) than the T1 group
Summary
Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture. The body mass index (BMI) has been used to evaluate the impact of obesity on cardiovascular disease, but recent studies have shown that the amount of visceral adipose tissue (VAT) evaluated by the waist-to-hip ratio or computed tomography (CT) findings is more closely associated with cardiovascular events than BMI [2,3]. VAT is an endocrine organ that produces large amounts of adipokines. Vulnerable plaques have an increased risk of rupture resulting in adverse coronary events [9,11]. The amount of VAT is closely associated with the characteristics of vulnerable coronary artery plaques [12,13,14]
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