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Measurement of abdominal fat by CT compared to waist circumference and BMI in explaining the presence of coronary calcium

Abstract

OBJECTIVE: To evaluate the association between standard and computed tomography (CT)-based measures of obesity and subclinical atherosclerosis, defined as coronary artery calcium (CAC) by Electron Beam Computed Tomography (EBCT).

DESIGN: Cross-sectional, observational study of anthropometric and CT obesity measures and presence of CAC.

SUBJECTS: Participants were 383 men and 379 women, aged 20–58 y and asymptomatic for coronary artery disease (CAD).

MEASUREMENTS: Intra-abdominal fat (IAF) and subcutaneous fat (SQF) were measured at the level of lumbar 2–3 and 4–5 spaces, using EBCT. Body mass index (BMI) was calculated from height and weight, and minimum waist circumference and maximum hip circumference were measured. CAC was measured by EBCT.

RESULTS: In both men and women, BMI, waist circumference, IAF, and SQF were significantly related to CAC. However, BMI or waist circumference explained variation in the presence of CAC as well as IAF or SQF, univariately and after adjustment for additional cardiovascular risk factors.

CONCLUSION: CT-based obesity exposure measures are not superior to BMI or waist circumference in association studies of subclinical CAD.

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References

  1. Grundy SM . Metabolic complications of obesity. Endocrine 2000; 13: 155–165.

    Article  CAS  Google Scholar 

  2. Spataro JA, Dyer AR, Stamler J, Shekelle RB, Greenlund K, Garside D . Measures of adiposity and coronary heart disease mortality in the Chicago Western Electric Company Study. J Clin Epidemiol 1996; 49: 849–857.

    Article  CAS  Google Scholar 

  3. Wilson PW, Kannel WB . Obesity, diabetes, and risk of cardiovascular disease in the elderly. Am J Geriatr Cardiol 2002; 11: 119–123, 125.

    Article  Google Scholar 

  4. Kannel WB, Wilson PW, Nam BH, D'Agostino RB . Risk stratification of obesity as a coronary risk factor. Am J Cardiol 2002; 90: 697–701.

    Article  Google Scholar 

  5. Eckel RH, Krauss RM . American Heart Association call to action: obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation 1998; 97: 2099–2100.

    Article  CAS  Google Scholar 

  6. Overweight, obesity, and health risk. National Task Force on the Prevention and Treatment of Obesity. Arch Intern Med 2000; 160: 898–904.

  7. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB . Annual deaths attributable to obesity in the United States. JAMA 1999; 282: 1530–1538.

    Article  CAS  Google Scholar 

  8. Eckel RH . Obesity and heart disease: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation 1997; 96: 3248–3250.

    Article  CAS  Google Scholar 

  9. Garrison RJ, Higgins MW, Kannel WB . Obesity and coronary heart disease. Curr Opin Lipidol 1996; 7: 199–202.

    Article  CAS  Google Scholar 

  10. Tochikubo O, Miyajima E, Okabe K, Imai K, Ishii M . Improvement of multiple coronary risk factors in obese hypertensives by reduction of intra-abdominal visceral fat. Jpn Heart J 1994; 35: 715–725.

    Article  CAS  Google Scholar 

  11. Lamarche B . Abdominal obesity and its metabolic complications: implications for the risk of ischaemic heart disease. Coron Artery Dis 1998; 9: 473–481.

    Article  CAS  Google Scholar 

  12. Bjorntorp P . Abdominal fat distribution and disease: an overview of epidemiological data. Ann Med 1992; 24: 15–18.

    Article  CAS  Google Scholar 

  13. Fujimoto WY, Bergstrom RW, Boyko EJ, Chen KW, Leonetti DL, Newell-Morris L, Shofer JB, Wahl PW . Visceral adiposity and incident coronary heart disease in Japanese-American men. The 10-year follow-up results of the Seattle Japanese-American Community Diabetes Study. Diabetes Care 1999; 22: 1808–1812.

    Article  CAS  Google Scholar 

  14. Kobayashi H, Nakamura T, Miyaoka K, Nishida M, Funahashi T, Yamashita S, Matsuzawa Y . Visceral fat accumulation contributes to insulin resistance, small-sized low-density lipoprotein, and progression of coronary artery disease in middle-aged non-obese Japanese men. Jpn Circ J 2001; 65: 193–199.

    Article  CAS  Google Scholar 

  15. Kortelainen ML, Sarkioja T . Visceral fat and coronary pathology in male adolescents. Int J Obes Relat Metab Disord 2001; 25: 228–232.

    Article  CAS  Google Scholar 

  16. Matsuzawa Y, Shimomura I, Nakamura T, Keno Y, Kotani K, Tokunaga K . Pathophysiology and pathogenesis of visceral fat obesity. Obes Res 1995; 3 (Suppl 2): 187S–194S.

    Article  Google Scholar 

  17. Enos WF, Holmes RH, Beyer J . Landmark article, July 18, 1953: coronary disease among United States soldiers killed in action in Korea. Preliminary report. By William F Enos, Robert H Holmes and James Beyer. JAMA 1986; 256: 2859–2862.

    Article  CAS  Google Scholar 

  18. Wissler RW . USA Multicenter Study of the pathobiology of atherosclerosis in youth. Ann N Y Acad Sci 1991; 623: 26–39.

    Article  CAS  Google Scholar 

  19. Strong JP, Malcom GT, McMahan CA, Tracy RE, Newman III WP, Herderick EE, Cornhill JF . Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA 1999; 281: 727–735.

    Article  CAS  Google Scholar 

  20. Adams MR, Celermajer DS . Detection of presymptomatic atherosclerosis: a current perspective. Clin Sci (London) 1999; 97: 615–624.

    Article  CAS  Google Scholar 

  21. Barth JD . Calcium scores low: ACC/AHA consensus statement on EBCT. Int J Clin Pract 2000; 54: 415.

    CAS  PubMed  Google Scholar 

  22. Bryan CS . Primary prevention of myocardial infarction: a role for electron beam computed tomography (EBCT)? J S C Med Assoc 1998; 94: 127–130.

    CAS  PubMed  Google Scholar 

  23. Cham BE . Plaque cholesterol and calcium: the value of EBCT in the detection of coronary atherosclerosis. Eur J Clin Invest 2001; 31: 467–468.

    Article  CAS  Google Scholar 

  24. Taylor AJ, Feuerstein I, Wong H, Barko W, Brazaitis M, O'Malley PG . Do conventional risk factors predict subclinical coronary artery disease? Results from the Prospective Army Coronary Calcium Project. Am Heart J 2001; 141: 463–468.

    Article  CAS  Google Scholar 

  25. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R . Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827–832.

    Article  CAS  Google Scholar 

  26. Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD . Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol 2000; 36: 1253–1260.

    Article  CAS  Google Scholar 

  27. O’Malley PG, Taylor AJ, Gibbons RV, Feuerstein IM, Jones DL, Vernalis M, Brazaitis M . Rationale and design of the Prospective Army Coronary Calcium (PACC) Study: utility of electron beam computed tomography as a screening test for coronary artery disease and as an intervention for risk factor modification among young, asymptomatic, active-duty United States Army Personnel. Am Heart J 1999; 137: 932–941.

    Article  Google Scholar 

  28. Budoff MJ, Raggi P . Coronary artery disease progression assessed by electron-beam computed tomography. Am J Cardiol 2001; 88 (2-A): 46E–50E.

    Article  CAS  Google Scholar 

  29. Wayhs R, Zelinger A, Raggi P . High coronary artery calcium scores pose an extremely elevated risk for hard events. J Am Coll Cardiol 2002; 39: 225–230.

    Article  Google Scholar 

  30. Raggi P, Cooil B, Callister TQ . Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J 2001; 141: 375–382.

    Article  CAS  Google Scholar 

  31. Baumgart D, Schmermund A, Goerge G, Haude M, Ge J, Adamzik M, Sehnert C, Altmaier K, Groenemeyer D, Seibel R, Erbel R . Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol 1997; 30: 57–64.

    Article  CAS  Google Scholar 

  32. Bielak LF, Rumberger JA, Sheedy II PF, Schwartz RS, Peyser PA . Probabilistic model for prediction of angiographically defined obstructive coronary artery disease using electron beam computed tomography calcium score strata. Circulation 2000; 102: 380–385.

    Article  CAS  Google Scholar 

  33. O’Rourke RA, Brundage BH, Froelicher VF, Greenland P, Grundy SM, Hachamovitch R, Pohost GM, Shaw LJ, Weintraub WS, Winters Jr WL, Forrester JS, Douglas PS, Faxon DP, Fisher JD, Gregoratos G, Hochman JS, Hutter Jr AM, Kaul S, Wolk MJ . American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 2000; 102: 126–140.

    Article  Google Scholar 

  34. SAS Institute Inc. SAS/STAT User's Guide, Version 6, Vol 2, 4th edn. SAS Institute Inc.: Cary, NC; 1989.

  35. Lindsey JK, Jones B . Choosing among generalized linear models applied to medical data. Stat Med 1998; 17: 59–68.

    Article  CAS  Google Scholar 

  36. Tirkes AT, Gottlieb RH, Voci SL, Waldman DL, Masetta J, Conover DL . Risk of significant coronary artery disease as determined by CT measurement of the distribution of abdominal adipose tissue. J Comput Assist Tomogr 2002; 26: 210–215.

    Article  Google Scholar 

  37. 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 

  38. 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  Google Scholar 

  39. Pereira MA, Schreiner PJ, Pankow JS, Williams RR, Higgins M, Province MA, Rao DC . The Family Risk Score for coronary heart disease: associations with lipids, lipoproteins, and body habitus in a middle-aged bi-racial cohort: The ARIC study. Ann Epidemiol 2000; 10: 239–245.

    Article  CAS  Google Scholar 

  40. Folsom AR, Burke GL, Byers CL, Hutchinson RG, Heiss G, Flack JM, Jacobs Jr DR, Caan B . Implications of obesity for cardiovascular disease in blacks: the CARDIA and ARIC studies. Am J Clin Nutr 1991; 53 (6 Suppl): 1604S–1611S.

    Article  CAS  Google Scholar 

  41. Lamarche B, Lemieux S, Dagenais GR, Despres JP . Visceral obesity and the risk of ischaemic heart disease: insights from the Quebec Cardiovascular Study. Growth Horm IGF Res 1998; 8 (Suppl B): 1–8.

    Article  Google Scholar 

  42. Haffner SM . Obesity and the metabolic syndrome: the San Antonio Heart Study. Br J Nutr 2000; 83 (Suppl 1): S67–S70.

    CAS  PubMed  Google Scholar 

  43. Nagaretani H, Nakamura T, Funahashi T, Kotani K, Miyanaga M, Tokunaga K, Takahashi M, Nishizawa H, Kishida K, Kuriyama H, Hotta K, Yamashita S, Matsuzawa Y . Visceral fat is a major contributor for multiple risk factor clustering in Japanese men with impaired glucose tolerance. Diabetes Care 2001; 24: 2127–2133.

    Article  CAS  Google Scholar 

  44. Lynch NA, Nicklas BJ, Berman DM, Dennis KE, Goldberg AP . Reductions in visceral fat during weight loss and walking are associated with improvements in VO(2 max). J Appl Physiol 2001; 90: 99–104.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Support for this study was provided by the NIH National Heart, Lung and Blood Institute Grant R01 HL61753 and DERC Clinical Investigation Core P30 DK57516. The study was performed at the Adult General Clinical Research Center at the University of Colorado Health Sciences Center supported by the NIH M01 RR00051, at the Barbara Davis Center for Childhood Diabetes in Denver, CO, and at Colorado Heart Imaging Center in Denver, CO. We thank the GCRC nursing staff and Core Laboratory, and the staff at Colorado Heart Imaging Center, for their assistance.

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Correspondence to J K Snell-Bergeon.

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Snell-Bergeon, J., Hokanson, J., Kinney, G. et al. Measurement of abdominal fat by CT compared to waist circumference and BMI in explaining the presence of coronary calcium. Int J Obes 28, 1594–1599 (2004). https://doi.org/10.1038/sj.ijo.0802796

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