Impact of abdominal fat distribution, visceral fat, and subcutaneous fat on coronary plaque scores assessed by 320-row computed tomography coronary angiography

doi:10.1016/j.atherosclerosis.2019.06.910

Atherosclerosis

Volume 287, August 2019, Pages 155-161

https://doi.org/10.1016/j.atherosclerosis.2019.06.910 Get rights and content

Highlights

•
Abdominal visceral fat area correlated with coronary plaque scores, whereas abdominal subcutaneous fat area inversely correlated with those scores.
•
Higher SAT and lower VAT were inversely correlated with the extent and severity of coronary artery plaques.
•
Fat distribution may be a useful tool for evaluating risk and prognosis of coronary artery disease.

Abstract

Background and aims

Obesity is a risk factor for coronary artery disease (CAD), but the association between fat distribution, i.e., visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and coronary artery plaque morphology remains unclear. This study explored the association between abdominal fat distribution and coronary artery plaques.

Methods

We retrospectively evaluated 4327 consecutive patients without CAD history, undergoing coronary computed tomography (CT) angiography. Plaques were assessed using segment stenosis score (SSS) and segment involvement score (SIS). We evaluated abdominal VAT and SAT areas using CT images. Patients were categorized into four groups: low VAT (<median)/low SAT (<median); low VAT/high SAT (≥median); high VAT (≥median)/low SAT; and high VAT/high SAT.

Results

Mean age was 65 years (men, 66.4%). VAT area correlated with SSS (β-coefficient = 0.11, p < 0.001) and SIS (β-coefficient = 0.006, p < 0.001), whereas SAT area was inversely correlated with SSS (β-coefficient = −0.007,p < 0.001) and SIS (β-coefficient = −0.004, p < 0.001). The low VAT/high SAT group had the lowest risk of higher SSS (≥5) and SIS (≥5) (odds ratio [OR] using low VAT/low SAT group as the reference category, 0.76, 95% confidence interval [CI], 0.61–0.95, p < 0.05; OR, 0.68, 95% CI, 0.53–0.88, p < 0.01, respectively) in multivariate analysis adjusted for age, sex, and traditional CAD risk factors. In the obese population (body mass index ≥25, n = 1694), the low VAT/high SAT group had the lowest risk of higher coronary plaque scores.

Conclusions

Higher SAT and lower VAT were inversely correlated with the extent and severity of coronary artery plaques. Fat distribution may be useful for evaluating risk and prognosis of CAD.

Graphical abstract

Introduction

Worldwide prevalence of obesity has increased in the past decades. Mean body mass index (BMI) has increased worldwide by 0.4 kg/m² per decade for men and 0.5 kg/m² for women [1]. Obesity is considered a risk factor for coronary artery disease (CAD) [2]. Since obesity is associated with increased blood pressure, dyslipidemia, and type 2 diabetes mellitus [3,4], obese individuals are more likely to develop cardiovascular disease.

Recently, many large studies and meta-analyses have demonstrated the presence of an “obesity paradox”: obese patients with CAD (BMI, 25.0–34.9 kg/m²) have a better prognosis than those with a normal BMI (18.5–24.9 kg/m²) [3,5,6]. This suggests that the metabolic effects of obesity may be protective against the development of CAD [7].

Previous studies have investigated body composition and adipose tissue distribution [8]. Abdominal visceral fat correlates with prevalence of CAD and mortality [9,10], whereas subcutaneous fat may play a protective role against the development of CAD through the improvement of insulin sensitivity or secretion of adipokines [[11], [12], [13]]. Distribution of adipose tissue, i.e. visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), may be associated with the development and prognosis of CAD. However, association between the extent and severity of coronary artery plaques and abdominal fat distribution remains unclear.

The recent introduction of multidetector coronary computed tomographic angiography (CCTA) offers a novel noninvasive approach for the evaluation of CAD [14]. In addition to high diagnostic accuracy for detection of CAD and high negative predictive value for excluding the presence of obstructive CAD [15], CCTA enables prediction of prognosis in individuals with stable CAD using CCTA scores, which are calculated from the severity and extent of coronary artery plaques, segment stenosis score (SSS), and segment involvement score (SIS) [16].

The aim of this study was to evaluate the association between fat distribution and severity and extent of coronary artery plaque assessed by CCTA plaque scores.

Section snippets

Study population

We retrospectively evaluated 5756 consecutive patients who underwent CCTA at our institution between January 2009 and May 2017. Of these, 1429 patients with a prior history of percutaneous coronary intervention or coronary artery bypass graft were excluded, leaving a total of 4327 patients. All patients provided written informed consent prior to study enrollment and the identities of these patients have been protected. The study protocol was approved by the medical ethical committee.

Clinical characteristics of the study population

Table 1 shows the baseline characteristics of the study population (4327 patients). The mean age was 65.0 ± 11.9 years, and 66% were male. The mean BMI was 24.4 ± 4.0 kg/m². The median VAT area, SAT area, and WC of the study population were 113.3 cm² (interquartile range, 71.7, 156.5), 139.5 cm² (98.4, 184.5), and 85.3 cm (78.4, 92.1), respectively. Both BMI and WC significantly correlated to VAT area or SAT area (Supplemental Table 1).

The baseline characteristics of the four fat composition

Discussion

This study demonstrates that abdominal fat distribution, VAT and SAT, are associated with coronary plaque scores—SSS and SIS assessed by CCTA. Neither VAT area nor SAT area was an independent predictor of high coronary plaque score (SSS ≥5 or SIS ≥5); however, the combination of VAT area and SAT area was an independent predictor. Patients with lower VAT area and higher SAT area had lower coronary plaque scores than those in other groups, which suggested that both increases in subcutaneous fat

Conflicts of interest

Dr. Tanabe receives remuneration from Canon Medical Systems. The remaining authors report no conflicts of interest.

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Impact of abdominal fat distribution, visceral fat, and subcutaneous fat on coronary plaque scores assessed by 320-row computed tomography coronary angiography

Highlights

Abstract

Background and aims

Methods

Results

Conclusions

Graphical abstract

Introduction

Section snippets

Study population

Clinical characteristics of the study population

Discussion

Conflicts of interest

Lancet

Prog. Cardiovasc. Dis.

Prog. Cardiovasc. Dis.

Lancet

J. Am. Coll. Cardiol.

J. Am. Coll. Cardiol.

Atherosclerosis

J. Am. Coll. Cardiol.

J. Am. Coll. Cardiol.

J. Am. Coll. Cardiol.

Int. J. Cardiol.

J. Am. Coll. Cardiol.

JACC Cardiovasc Imaging

Cell Metabol.

Atherosclerosis

Rev. Esp. Cardiol.