Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Atherosclerosis. 2019 Aug;287:155-161. doi: 10.1016/j.atherosclerosis.2019.06.910. Epub 2019 Jun 24.
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.
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.
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.
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.
肥胖是冠心病（CAD）的一个危险因素，但脂肪分布（即内脏脂肪组织 [VAT] 和皮下脂肪组织 [SAT]）与冠状动脉斑块形态之间的关系仍不清楚。本研究旨在探讨腹部脂肪分布与冠状动脉斑块之间的关系。
我们回顾性评估了 4327 例无 CAD 病史、接受冠状动脉计算机断层扫描（CT）血管造影的连续患者。使用节段狭窄评分（SSS）和节段受累评分（SIS）评估斑块。我们使用 CT 图像评估腹部 VAT 和 SAT 区域。患者分为四组：低 VAT（<中位数）/低 SAT（<中位数）；低 VAT/高 SAT（≥中位数）；高 VAT（≥中位数）/低 SAT；高 VAT/高 SAT。
平均年龄为 65 岁（男性为 66.4%）。VAT 面积与 SSS（β 系数=0.11，p<0.001）和 SIS（β 系数=0.006，p<0.001）呈正相关，而 SAT 面积与 SSS（β 系数=-0.007，p<0.001）和 SIS（β 系数=-0.004，p<0.001）呈负相关。低 VAT/高 SAT 组的 SSS（≥5）和 SIS（≥5）发生率最低（与低 VAT/低 SAT 组相比，优势比[OR]，0.76，95%置信区间[CI]，0.61-0.95，p<0.05；OR，0.68，95%CI，0.53-0.88，p<0.01），经年龄、性别和传统 CAD 危险因素调整后的多变量分析。在肥胖人群（体重指数≥25，n=1694）中，低 VAT/高 SAT 组的冠状动脉斑块评分最低。
SAT 较高和 VAT 较低与冠状动脉斑块的范围和严重程度呈负相关。脂肪分布可能有助于评估 CAD 的风险和预后。
