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Differential association of visceral adipose tissue with coronary plaque characteristics in patients with and without diabetes mellitus.

Osawa K, Miyoshi T, Koyama Y, Sato S, Akagi N, Morimitsu Y, Kubo M, Sugiyama H, Nakamura K, Morita H, Kanazawa S, Ito H - Cardiovasc Diabetol (2014)

Bottom Line: Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture.Patients were divided into tertiles according to the VAT area.CTA findings may help to improve risk stratification in such patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular Therapeutics, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. miyoshit@cc.okayama-u.ac.jp.

ABSTRACT

Background: Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture. Patients with diabetes mellitus (DM) have more VAT than patients without DM, but the extent to which VAT contributes to the characteristics of coronary plaques before and after the development of DM is not fully understood.

Methods: We retrospectively evaluated 456 patients (60% male, age 64 ± 16 years) who were suspected to have cardiovascular disease and underwent 64-slice computed tomography angiography (CTA). Seventy-one (16%) patients had vulnerable plaques (CT density < 50 Hounsfield Units, positive remodeling index > 1.05, and adjacent spotty areas of calcification).

Results: Patients were divided into tertiles according to the VAT area. There were stepwise increases in noncalcified and vulnerable plaques with increasing tertiles of VAT area in patients without DM, but not in patients with DM. Multivariate analysis showed that a larger VAT area was significantly associated with a higher risk of vulnerable plaque in patients without DM (odds ratio 3.17, 95% confidence interval 1.08-9.31, p = 0.04), but not in patients with DM.

Conclusions: The VAT area is associated with the characteristics of coronary plaques on CTA in patients without DM, but not in patients with DM. VAT may be a significant cardiometabolic risk factor that is associated with plaque vulnerability before the development of DM. CTA findings may help to improve risk stratification in such patients.

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Prevalences of plaque characteristics according to VAT area tertile in patients with and without DM. CP, calcified plaque; NCP, noncalcified plaque; PR, positive remodeling; LDP, low-density plaque; SC, spotty calcification. *p < 0.05 vs. T1 group; †p < 0.05 vs. T2 group.
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Figure 1: Prevalences of plaque characteristics according to VAT area tertile in patients with and without DM. CP, calcified plaque; NCP, noncalcified plaque; PR, positive remodeling; LDP, low-density plaque; SC, spotty calcification. *p < 0.05 vs. T1 group; †p < 0.05 vs. T2 group.

Mentions: Figure 1 shows the prevalence of plaque characteristics according to the VAT area tertile in patients with and without DM. In patients with DM, there were no significant differences in the prevalence of any of the plaque characteristics among the tertiles. In patients without DM, there was a stepwise increase in the prevalence of each plaque characteristics from the T1 group to the T3 group. The T1 group had a lower prevalence than the T2 and T3 groups of positive remodeling (25 vs. 47 and 50%, p < 0.01), low-density plaques (9 vs. 22 and 24%, p < 0.01), adjacent areas of spotty calcification (5 vs. 14 and 22%, p = 0.01), and all three of these characteristics (5 vs. 14 and 21%, p = 0.02). Figure 2 shows the prevalence of plaque characteristics according to the BMI tertile in patients with and without DM. In patients without DM, there were no significant differences in the prevalence of calcified plaque, NCP, or positive remodeling among the tertiles. In patients with DM, the T2 group tended to have a higher prevalence of calcified plaque and positive remodeling than the T1 and the T3 groups. There was no significant difference in the prevalence of vulnerable plaques among the BMI tertiles. Figure 3 shows the prevalence of plaque characteristics according to the WC tertile in patients with and without DM. In patients without DM, the T1 group had a significantly lower prevalence of vulnerable plaque than the T2 group. Patients with DM had a similar trend in terms of the prevalence of vulnerable plaque among tertiles, but the differences were not significant. Figure 4 shows the prevalence of plaque characteristics according to the SAT tertile in patients with and without DM. In patients with and without DM, there was no significant difference in the prevalence of vulnerable plaque among tertiles.


Differential association of visceral adipose tissue with coronary plaque characteristics in patients with and without diabetes mellitus.

Osawa K, Miyoshi T, Koyama Y, Sato S, Akagi N, Morimitsu Y, Kubo M, Sugiyama H, Nakamura K, Morita H, Kanazawa S, Ito H - Cardiovasc Diabetol (2014)

Prevalences of plaque characteristics according to VAT area tertile in patients with and without DM. CP, calcified plaque; NCP, noncalcified plaque; PR, positive remodeling; LDP, low-density plaque; SC, spotty calcification. *p < 0.05 vs. T1 group; †p < 0.05 vs. T2 group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3975136&req=5

Figure 1: Prevalences of plaque characteristics according to VAT area tertile in patients with and without DM. CP, calcified plaque; NCP, noncalcified plaque; PR, positive remodeling; LDP, low-density plaque; SC, spotty calcification. *p < 0.05 vs. T1 group; †p < 0.05 vs. T2 group.
Mentions: Figure 1 shows the prevalence of plaque characteristics according to the VAT area tertile in patients with and without DM. In patients with DM, there were no significant differences in the prevalence of any of the plaque characteristics among the tertiles. In patients without DM, there was a stepwise increase in the prevalence of each plaque characteristics from the T1 group to the T3 group. The T1 group had a lower prevalence than the T2 and T3 groups of positive remodeling (25 vs. 47 and 50%, p < 0.01), low-density plaques (9 vs. 22 and 24%, p < 0.01), adjacent areas of spotty calcification (5 vs. 14 and 22%, p = 0.01), and all three of these characteristics (5 vs. 14 and 21%, p = 0.02). Figure 2 shows the prevalence of plaque characteristics according to the BMI tertile in patients with and without DM. In patients without DM, there were no significant differences in the prevalence of calcified plaque, NCP, or positive remodeling among the tertiles. In patients with DM, the T2 group tended to have a higher prevalence of calcified plaque and positive remodeling than the T1 and the T3 groups. There was no significant difference in the prevalence of vulnerable plaques among the BMI tertiles. Figure 3 shows the prevalence of plaque characteristics according to the WC tertile in patients with and without DM. In patients without DM, the T1 group had a significantly lower prevalence of vulnerable plaque than the T2 group. Patients with DM had a similar trend in terms of the prevalence of vulnerable plaque among tertiles, but the differences were not significant. Figure 4 shows the prevalence of plaque characteristics according to the SAT tertile in patients with and without DM. In patients with and without DM, there was no significant difference in the prevalence of vulnerable plaque among tertiles.

Bottom Line: Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture.Patients were divided into tertiles according to the VAT area.CTA findings may help to improve risk stratification in such patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular Therapeutics, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. miyoshit@cc.okayama-u.ac.jp.

ABSTRACT

Background: Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture. Patients with diabetes mellitus (DM) have more VAT than patients without DM, but the extent to which VAT contributes to the characteristics of coronary plaques before and after the development of DM is not fully understood.

Methods: We retrospectively evaluated 456 patients (60% male, age 64 ± 16 years) who were suspected to have cardiovascular disease and underwent 64-slice computed tomography angiography (CTA). Seventy-one (16%) patients had vulnerable plaques (CT density < 50 Hounsfield Units, positive remodeling index > 1.05, and adjacent spotty areas of calcification).

Results: Patients were divided into tertiles according to the VAT area. There were stepwise increases in noncalcified and vulnerable plaques with increasing tertiles of VAT area in patients without DM, but not in patients with DM. Multivariate analysis showed that a larger VAT area was significantly associated with a higher risk of vulnerable plaque in patients without DM (odds ratio 3.17, 95% confidence interval 1.08-9.31, p = 0.04), but not in patients with DM.

Conclusions: The VAT area is associated with the characteristics of coronary plaques on CTA in patients without DM, but not in patients with DM. VAT may be a significant cardiometabolic risk factor that is associated with plaque vulnerability before the development of DM. CTA findings may help to improve risk stratification in such patients.

Show MeSH
Related in: MedlinePlus