Diabetes Metab J.  2021 Mar;45(2):219-230. 10.4093/dmj.2019.0161.

Clinical Significance of Body Fat Distribution in Coronary Artery Calcification Progression in Korean Population

• Lee H
• Park HE
• Yoon JW
• Choi SY

• KMID: 2514198
• DOI: http://doi.org/10.4093/dmj.2019.0161

Abstract

Background
Although obesity differs according to ethnicity, it is globally established as a solid risk factor for cardiovascular disease. However, it is not fully understood how obesity parameters affect the progression of coronary artery calcification (CAC) in Korean population. We sought to evaluate the association of obesity-related parameters including visceral adipose tissue (VAT) measurement and CAC progression.
Methods
This retrospective observational cohort study investigated 1,015 asymptomatic Korean subjects who underwent serial CAC scoring by computed tomography (CT) with at least 1-year interval and adipose tissue measurement using non-contrast CT at baseline for a routine checkup between 2003 and 2015. CAC progression, the main outcome, was defined as a difference of ≥2.5 between the square roots of the baseline and follow-up CAC scores using Agatston units.
Results
During follow-up (median 39 months), 37.5% of subjects showed CAC progression of a total population (56.4 years, 80.6% male). Body mass index (BMI) ≥25 kg/m², increasing waist circumferences (WC), and higher VAT/subcutaneous adipose tissue (SAT) area ratio were independently associated with CAC progression. Particularly, predominance of VAT over SAT at ≥30% showed the strongest prediction for CAC progression (adjusted hazard ratio, 2.20; P<0.001) and remained of prognostic value regardless of BMI or WC status. Further, it provided improved risk stratification of CAC progression beyond known prognosticators.
Conclusion
Predominant VAT area on CT is the strongest predictor of CAC progression regardless of BMI or WC in apparently healthy Korean population. Assessment of body fat distribution may be helpful to identify subjects at higher risk.

Keyword

Body fat distribution; Coronary artery disease; Multidetector computed tomography; Obesity, abdominal

Figure

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  Fig. 1. The distribution of coronary artery calcium scores (CACS) at (A) baseline and (B) follow-up calcium scans. CAC, coronary artery calcification.

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  Fig. 2. Kaplan-Meier curve for the risk of coronary artery calcification (CAC) progression according to visceral adipose tissue (VAT) on computed tomography. When stratified by VAT quartiles, the risk of CAC progression tended to increase gradually with increasing VAT areas. CI, confidence interval; HR, hazard ratio; Q, quartile. aThe multivariable model was adjusted for Framingham risk score, a history of diabetes mellitus, and higher high-sensitivity C-reactive protein.

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  Fig. 3. Kaplan-Meier curve for the risk of coronary artery calcification (CAC) progression according to visceral adipose tissue (VAT)/subcutaneous adipose tissue (SAT) ratio on computed tomography. VAT/SAT ratio ≥1.30 (dark blue solid line) showed a significant increase in the risk of CAC progression. After 5 years of follow-up, the risk of CAC progression in subject with VAT/SAT ratio ≥1.30 was approximately twice as high as those with VAT/SAT <1.30.

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