Introduction
Methods
Study population
Prognostic follow-up
Ascertainment of risk factors at baseline
Definition of the metabolic syndrome
Image acquisition
CAC measurement
Deep learning-based EAT quantification
Liver fat measurement
Serum biomarkers
Statistical analysis
Results
Baseline characteristics
Total participants | MetS | No MetS | P value | |
---|---|---|---|---|
(n = 2068) | (n = 280) | (n = 1788) | ||
Demographics | ||||
Age, years | 55.6 ± 9.1 | 56.4 ± 8.4 | 55.5 ± 9.2 | 0.10 |
Male gender | 1220 (59.0) | 166 (59.3) | 1060 (59.3) | 1.00 |
BMI, kg/m2 | 26.6 ± 4.9 | 34.9 ± 5.2 | 25.3 ± 3.3 | < 0.001 |
Systolic blood pressure, mmHg | 128.8 ± 18.4 | 137.6 ± 17.5 | 127.4 ± 18.2 | < 0.001 |
Diastolic blood pressure, mmHg | 77.1 ± 11.8 | 81.9 ± 12.3 | 76.3 ± 11.6 | < 0.001 |
Dyslipidemia | 1439 (69.6) | 212 (75.7) | 1227 (68.6) | 0.02 |
Hypertension | 834 (40.3) | 186 (66.4) | 648 (36.2) | < 0.001 |
Diabetes mellitus | 119 (5.8) | 46 (16.4) | 73 (4.1) | < 0.001 |
Family history of CAD | 623 (30.1) | 79 (28.2) | 544 (30.4) | 0.48 |
Current smoker | 48 (2.3) | 8 (2.9) | 40 (2.2) | 0.19 |
Past smoker | 81 (3.9) | 12 (4.3) | 69 (3.9) | 0.26 |
ASCVD risk, % | 5.2 (2.6–10.1) | 8.1 (4.8–15.2) | 4.8 (2.3–9.4) | < 0.001 |
Medications | ||||
Aspirin | 244 (11.8) | 51 (18.4) | 193 (10.8) | 0.005 |
Statin | 449 (21.7) | 93 (33.2) | 356 (19.9) | < 0.001 |
ACE-inhibitor/ARB | 175 (8.5) | 51 (18.2) | 124 (6.9) | < 0.001 |
Beta blocker | 145 (7.0) | 30 (10.8) | 115 (6.4) | 0.04 |
Diuretic | 157 (7.6) | 40 (14.3) | 117 (6.5) | 0.001 |
Quantitative CT measures | ||||
CAC score | 0 (0–56.6) | 5.6 (0–92.3) | 0 (0–50.8) | 0.001 |
CAC score category | ||||
0 | 1084 (52.4) | 123 (43.9) | 961 (53.7) | 0.002 |
1–100 | 590 (28.5) | 90 (32.1) | 500 (28.0) | 0.16 |
101–400 | 241 (11.7) | 43 (15.4) | 198 (11.1) | 0.05 |
> 400 | 153 (7.4) | 24 (8.6) | 129 (7.2) | 0.39 |
EAT volume, cm3 | 78.3 (55.7–106.0) | 114.1 (90.7–147.8) | 73.7 (53.7–98.7) | < 0.001 |
EAT attenuation, HU | −73.8 ± 4.8 | −76.9 ± 4.6 | −73.4 ± 4.6 | < 0.001 |
Liver attenuation, HUa | 64.5±11.6 | 54.8±12.6 | 65.8 ± 10.3 | < 0.001 |
NAFLDa | 242/1962 (12.3) | 71/273 (26.0) | 171/1689 (10.1) | < 0.001 |
Laboratory values | ||||
Total cholesterol, mg/dL | 210.9 ± 40.1 | 210.5 ± 43.3 | 211.0 ± 39.6 | 0.85 |
LDL cholesterol, mg/dL | 131.3 ± 37.2 | 130.5 ± 37.6 | 131.4 ± 37.1 | 0.71 |
HDL cholesterol, mg/dL | 55.2 ± 17.1 | 44.7 ± 13.4 | 56.8 ± 17.1 | < 0.001 |
Triglycerides, mg/dL | 105.0 (74.0–152.0) | 158.5 (114.5–213.0) | 99.0 (70.0–140.0) | < 0.001 |
Fasting glucose, mg/dL | 96.1 ± 16.9 | 102.8 ± 25.5 | 95.0 ± 14.8 | < 0.001 |
Noncontrast CT measures
MetS and EAT measures as predictors of MACE
HR | 95% CI | P value | |
---|---|---|---|
Model 1 | |||
MetS/diabetes status | |||
No MetS or diabetes | 1.00 (Reference) | ||
MetS (no diabetes) | 1.62 | 1.13–2.34 | 0.01 |
Diabetes | 1.78 | 1.11–2.84 | 0.02 |
Age, years | 1.07 | 1.05–1.08 | < 0.001 |
Male sex | 1.83 | 1.37–2.44 | < 0.001 |
LDL cholesterol, mmol/L | 1.02 | 1.01–1.03 | 0.01 |
Model 2: Model 1 + CAC score | |||
CAC scorea | 1.28 | 1.22–1.33 | < 0.001 |
Mets/diabetes status | |||
No MetS or diabetes | 1.00 (Reference) | ||
MetS (no diabetes) | 1.58 | 1.10–2.27 | 0.01 |
Diabetes | 1.44 | 0.90–2.30 | 0.13 |
Model 3: Model 2 + EAT volumeb | |||
EAT volume, cm3a | 1.52 | 1.23–1.89 | < 0.001 |
CAC score | 1.28 | 1.23–1.33 | < 0.001 |
Model 4: Model 2 + EAT attenuationb | |||
EAT attenuation, HU | 0.95 | 0.93–0.98 | < 0.001 |
CAC score | 1.27 | 1.21–1.32 | < 0.001 |
NRI | 95% CI | P value | % of events correctly reclassified | Event P value | % of non-events correctly reclassified | Non-event P value | |
---|---|---|---|---|---|---|---|
ASCVD risk score + EAT volume | 0.218 | 0.079-0.357 | 0.002 | 14 | 0.04 | 8 | < 0.001 |
ASCVD + CAC score + EAT volume | 0.171 | 0.032-0.310 | 0.001 | 11 | 0.01 | 6 | 0.009 |
ASCVD risk score + EAT attenuation | 0.167 | 0.038-0.31 | 0.01 | 5 | 0.08 | 12 | < 0.001 |
ASCVD + CAC score + EAT attenuation | 0.126 | 0.014-0.266 | 0.02 | 4 | 0.09 | 9 | < 0.001 |
NAFLD as a predictor of MACE
HR | 95% CI | P value | |
---|---|---|---|
Model 1: adjusted for CAC score + EAT volume | |||
NAFLD | 1.78 | 1.21–2.61 | 0.003 |
EAT volume, cm3a | 1.48 | 1.18–1.86 | 0.001 |
CAC scorea | 1.28 | 1.23–1.33 | < 0.001 |
Model 2: adjusted for CAC score + EAT attenuation | |||
NAFLD | 1.80 | 1.23–2.65 | 0.003 |
EAT attenuation, HU | 0.96 | 0.93–0.98 | 0.002 |
CAC score | 1.28 | 1.23–1.34 | < 0.001 |