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Visceral adipose tissue area is associated with coronary stenosis and noncalcified plaques

International Journal of Obesity volume 38, pages 272–278 (2014)Cite this article

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Abstract

Objective:

Few studies have investigated the relationships between visceral adipose tissue (VAT) and coronary stenosis and noncalcified plaques at the subclinical stage. The aim of this study was to investigate relationship between VAT and coronary lesions assessed by coronary computed tomography (CT) in an apparently healthy population.

Design:

Retrospective cross-sectional study.

Subjects:

One thousand six hundred and fifty-eight subjects free of cardiovascular disease underwent coronary CT and abdominal fat CT as part of a routine medical examination.

Measurement:

VAT area was measured at the level of the umbilicus using CT. Coronary stenoses and plaques were evaluated using coronary CT.

Results:

The mean age of the study population was 55.9±8.0 years, and 1198 (72.3%) subjects were men. There were 201 subjects (12.1%) with coronary stenosis <50% and 144 (8.7%) had significant stenosis. Noncalcified plaques were observed in 108 (6.5%) subjects. Coronary stenosis <50% and noncalcified plaques increased steadily as the VAT area increased (P<0.001). The 4th quartile of VAT area was significantly associated with prevalence of coronary stenosis <50% and the presence of noncalcified plaques when compared with the first through third VAT quartiles in the cardiovascular risk factor-adjusted model (odds ratio (OR): 1.58, 95% confidence interval (CI): 1.09–2.30 and OR: 1.66; 95% CI: 1.02–2.68, respectively).

Conclusion:

Excess VAT area was associated with coronary stenosis <50% and noncalcified plaques, independent of traditional cardiovascular risk factors, in an asymptomatic population without a history of coronary artery disease.

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References

  1. James PT, Rigby N, Leach R . The obesity epidemic, metabolic syndrome and future prevention strategies. Eur J Cardiovasc Prev Rehabil 2004; 11: 3–8.

    Article  PubMed  Google Scholar 

  2. Wilson PW, D'Agostino RB, Sullivan L, Parise H, Kannel WB . Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002; 162: 1867–1872.

    Article  PubMed  Google Scholar 

  3. Ascaso JF, Romero P, Real JT, Lorente RI, Martinez-Valls J, Carmena R . Abdominal obesity, insulin resistance, and metabolic syndrome in a southern European population. Eur J Intern Med 2003; 14: 101–106.

    Article  CAS  PubMed  Google Scholar 

  4. Eckel RH, Kahn R, Robertson RM, Rizza RA . Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes Association and the American Heart Association. Circulation 2006; 113: 2943–2946.

    Article  PubMed  Google Scholar 

  5. Despres JP, Lemieux I . Abdominal obesity and metabolic syndrome. Nature 2006; 444: 881–887.

    Article  CAS  PubMed  Google Scholar 

  6. Despres JP . Is visceral obesity the cause of the metabolic syndrome? Ann Med 2006; 38: 52–63.

    Article  CAS  PubMed  Google Scholar 

  7. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu C et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 2007; 116: 39–48.

    Article  PubMed  Google Scholar 

  8. Pou KM, Massaro JM, Hoffmann U, Vasan RS, Maurovich-Horvat P, Larson MG et al. Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study. Circulation 2007; 116: 1234–1241.

    Article  CAS  PubMed  Google Scholar 

  9. Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation 2008; 117: 605–613.

    Article  PubMed  Google Scholar 

  10. Ohashi N, Yamamoto H, Horiguchi J, Kitagawa T, Kunita E, Utsunomiya H et al. Association between visceral adipose tissue area and coronary plaque morphology assessed by CT angiography. JACC Cardiovasc Imaging 2010; 3: 908–917.

    Article  PubMed  Google Scholar 

  11. Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 2007; 50: 319–326.

    Article  PubMed  Google Scholar 

  12. Leber AW, Becker A, Knez A, von Ziegler F, Sirol M, Nikolaou K et al. Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 2006; 47: 672–677.

    Article  PubMed  Google Scholar 

  13. Imai A, Komatsu S, Ohara T, Kamata T, Yoshida J, Miyaji K et al. Visceral abdominal fat accumulation predicts the progression of noncalcified coronary plaque. Atherosclerosis 2012; 222: 524–529.

    Article  CAS  PubMed  Google Scholar 

  14. Khashper A, Gaspar T, Azencot M, Dobrecky-Mery I, Peled N, Lewis BS et al. Visceral abdominal adipose tissue and coronary atherosclerosis in asymptomatic diabetics. Int J Cardiol 2013; 162: 184–188.

    Article  PubMed  Google Scholar 

  15. Gastaldelli A, Cusi K, Pettiti M, Hardies J, Miyazaki Y, Berria R et al. Relationship between hepatic/visceral fat and hepatic insulin resistance in nondiabetic and type 2 diabetic subjects. Gastroenterology 2007; 133: 496–506.

    Article  CAS  PubMed  Google Scholar 

  16. Hou ZH, Lu B, Gao Y, Jiang SL, Wang Y, Li W et al. Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. JACC Cardiovasc Imaging 2012; 5: 990–999.

    Article  PubMed  Google Scholar 

  17. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB . Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837–1847.

    Article  CAS  PubMed  Google Scholar 

  18. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–3421.

    Article  Google Scholar 

  19. Choi SY, Kim D, Oh BH, Kim M, Park HE, Lee CH et al. General and abdominal obesity and abdominal visceral fat accumulation associated with coronary artery calcification in Korean men. Atherosclerosis 2010; 213: 273–278.

    Article  CAS  PubMed  Google Scholar 

  20. Kvist H, Chowdhury B, Grangard U, Tylen U, Sjostrom L . Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr 1988; 48: 1351–1361.

    Article  CAS  PubMed  Google Scholar 

  21. Goodpaster BH . Measuring body fat distribution and content in humans. Curr Opin Clin Nutr Metab Care 2002; 5: 481–487.

    Article  PubMed  Google Scholar 

  22. Baumgartner RN, Heymsfield SB, Roche AF, Bernardino M . Abdominal composition quantified by computed tomography. Am J Clin Nutr 1988; 48: 936–945.

    Article  CAS  PubMed  Google Scholar 

  23. Thaete FL, Colberg SR, Burke T, Kelley DE . Reproducibility of computed tomography measurement of visceral adipose tissue area. Int J Obes Relat Metab Disord 1995; 19: 464–467.

    CAS  PubMed  Google Scholar 

  24. Chung SJ, Kim D, Park MJ, Kim YS, Kim JS, Jung HC et al. Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case-control study of 7078 Koreans undergoing health check-ups. Gut 2008; 57: 1360–1365.

    Article  CAS  PubMed  Google Scholar 

  25. Park HE, Kim MK, Choi SY, Lee W, Shin CS, Cho SH et al. The prevalence and distribution of coronary artery calcium in asymptomatic Korean population. Int J Cardiovasc Imaging 2012; 28: 1227–1235.

    Article  PubMed  Google Scholar 

  26. Park HE, Choi SY, Kim HS, Kim MK, Cho SH, Oh BH . Epicardial fat reflects arterial stiffness: assessment using 256-slice multidetector coronary computed tomography and cardio-ankle vascular index. J Atheroscler Thromb 2012; 19: 570–576.

    Article  PubMed  Google Scholar 

  27. Choi EK, Choi SI, Rivera JJ, Nasir K, Chang SA, Chun EJ et al. Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol 2008; 52: 357–365.

    Article  PubMed  Google Scholar 

  28. Ohashi N, Yamamoto H, Horiguchi J, Kitagawa T, Hirai N, Ito K et al. Visceral fat accumulation as a predictor of coronary artery calcium as assessed by multislice computed tomography in Japanese patients. Atherosclerosis 2009; 202: 192–199.

    Article  CAS  PubMed  Google Scholar 

  29. Yamagishi M, Terashima M, Awano K, Kijima M, Nakatani S, Daikoku S et al. Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome. J Am Coll Cardiol 2000; 35: 106–111.

    Article  CAS  PubMed  Google Scholar 

  30. Mahabadi AA, Massaro JM, Rosito GA, Levy D, Murabito JM, Wolf PA et al. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J 2009; 30: 850–856.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Marchington JM, Mattacks CA, Pond CM . Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties. Comp Biochem Physiol B 1989; 94: 225–232.

    Article  CAS  PubMed  Google Scholar 

  32. Marchington JM, Pond CM . Site-specific properties of pericardial and epicardial adipose tissue: the effects of insulin and high-fat feeding on lipogenesis and the incorporation of fatty acids in vitro. Int J Obes 1990; 14: 1013–1022.

    CAS  PubMed  Google Scholar 

  33. Fantuzzi G, Mazzone T . Adipose tissue and atherosclerosis: exploring the connection. Arterioscler Thromb Vasc Biol 2007; 27: 996–1003.

    Article  CAS  PubMed  Google Scholar 

  34. Van Gaal LF, Mertens IL, De Block CE . Mechanisms linking obesity with cardiovascular disease. Nature 2006; 444: 875–880.

    Article  CAS  PubMed  Google Scholar 

  35. Yatagai T, Nagasaka S, Taniguchi A, Fukushima M, Nakamura T, Kuroe A et al. Hypoadiponectinemia is associated with visceral fat accumulation and insulin resistance in Japanese men with type 2 diabetes mellitus. Metabolism 2003; 52: 1274–1278.

    Article  CAS  PubMed  Google Scholar 

  36. Saijo Y, Kiyota N, Kawasaki Y, Miyazaki Y, Kashimura J, Fukuda M et al. Relationship between C-reactive protein and visceral adipose tissue in healthy Japanese subjects. Diabetes Obes Metab 2004; 6: 249–258.

    Article  CAS  PubMed  Google Scholar 

  37. Fox CS, Hwang SJ, Massaro JM, Lieb K, Vasan RS, O’Donnell CJ et al. Relation of subcutaneous and visceral adipose tissue to coronary and abdominal aortic calcium (from the Framingham Heart Study). Am J Cardiol 2009; 104: 543–547.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Shemesh J, Stroh CI, Tenenbaum A, Hod H, Boyko V, Fisman EZ et al. Comparison of coronary calcium in stable angina pectoris and in first acute myocardial infarction utilizing double helical computerized tomography. Am J Cardiol 1998; 81: 271–275.

    Article  CAS  PubMed  Google Scholar 

  39. Ehara S, Kobayashi Y, Yoshiyama M, Shimada K, Shimada Y, Fukuda D et al. Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study. Circulation 2004; 110: 3424–3429.

    Article  PubMed  Google Scholar 

  40. Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, Decramer I, Van Hoe LR, Wijns W et al. Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology 2007; 244: 419–428.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Healthcare Research Institute, Seoul National University, Hospital Healthcare System Gangnam Center, Seoul, Korea

    S J Kang, D Kim, H E Park, S H Choi, S-Y Choi, J S Kim & S-H Cho

  2. Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

    W Lee

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  1. S J Kang
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Correspondence to D Kim.

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Kang, S., Kim, D., Park, H. et al. Visceral adipose tissue area is associated with coronary stenosis and noncalcified plaques. Int J Obes 38, 272–278 (2014). https://doi.org/10.1038/ijo.2013.105

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