The impact of central obesity on accelerated progression of noncalcified coronary plaque assessed by coronary CT angiography: a 4-year-follow-up study

Abstract

Purpose: Although excess visceral adipose tissue (VAT) is more strongly associated with risk factors of coronary artery disease (CAD) than body mass index (BMI) or waist circumference, an association between VAT and CAD progression has not been fully evaluated. The aim of this study was to investigate whether adding VAT measurements to CAD risk factors provides better risk assessment for progression of calcified and noncalcified coronary plaque on coronary CT angiography. Methods: This prospective cohort study comprised 553 CAD patients with calcified and noncalcified coronary plaque with ≤ 50% coronary stenosis as assessed by coronary CT angiography. Quantification of VAT area was performed using abdominal CT scanning. Results: After a mean 55±8 month follow-up, 332 patients underwent repeated CT scans for worsening angina symptoms without findings of positive ischemia. Increased segments of noncalcified plaque were seen in 161 (48%) and increases above the median calcium score were seen in 168 (51%) patients. The risk for progression of noncalcified plaque increased steadily with higher VAT quartiles, independent of CAD risk factors. Patients in the higher VAT quartiles were at increased risk of progression of noncalcified plaque (quartiles IV OR 5.5; 95% CI 2.8-11.0, p-value < 0.001). In contrast, increases above the median calcium score showed no independent correlation to VAT. Progression of noncalcified plaque showed no phased increase with either higher waist circumference or BMI quartiles. Conclusions: Excess VAT was positively associated with progression of noncalcified coronary plaque, but not of calcified plaque. This suggests that risk assessment of progression of noncalcified plaque can be improved by combining VAT measurements and CAD risk factors.