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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Impact of visceral fat on coronary artery disease as defined by quantitative computed tomography angiography
Daniel Karlsberg1,2,3, Henry Steyer4, Rebecca Fisher5
1The Princeton Longevity Center, New York, New York, USA.
Insights
Increased visceral fat (VF) correlates with more coronary artery plaque, including high-risk low-density noncalcified plaque (LD-NCP). This suggests VF may help predict cardiovascular disease (CVD) risk.
Area of Science:
- Cardiology
- Radiology
- Obesity Medicine
Background:
- Obesity is a significant risk factor for all-cause mortality and cardiovascular disease (CVD).
- Visceral fat (VF) is a key metric for CVD risk, independently linked to myocardial infarction and stroke.
- Understanding the relationship between VF and coronary artery plaque is crucial for CVD risk stratification.
Purpose of the Study:
- To investigate the association between the presence and severity of visceral fat (VF).
- To determine the relationship between VF and the presence and extent of coronary artery plaque.
- To explore the correlation between VF and specific types of coronary plaque, including low-density noncalcified plaque (LD-NCP).
Main Methods:
- 145 asymptomatic patients underwent atherosclerosis imaging-quantitative computed tomography (AI-QCT).
- AI-QCT assessed total plaque volume (TPV), noncalcified plaque (NCP), calcified plaque, LD-NCP, and stenosis.
- Visceral fat (VF) and subcutaneous fat volumes, waist circumference, and body fat percentage were quantified.
Main Results:
- A significant positive correlation was found between VF and TPV (r=0.22, p=0.0074), NCP (r=0.25, p=0.0023), and LD-NCP (r=0.37, p<0.0001).
- Coronary plaque volume, including TPV, NCP, and LD-NCP, progressively increased across quartiles of VF.
- Higher VF levels were strongly associated with increased amounts of LD-NCP, a high-risk plaque type.
Conclusions:
- Increased visceral fat (VF) is associated with greater coronary artery plaque burden, including TPV, NCP, and LD-NCP.
- The strong association between VF and LD-NCP highlights VF's potential role in identifying individuals at high risk for future cardiovascular events.
- Visceral fat (VF) may serve as a valuable tool for cardiovascular disease (CVD) risk stratification.
Objective:
Obesity is associated with all-cause mortality and cardiovascular disease (CVD). Visceral fat (VF) is an important CVD risk metric given its independent correlation with myocardial infarction and stroke. This study aims to clarify the relationship between the presence and severity of VF with the presence and severity of coronary artery plaque.
Methods:
In 145 consecutive asymptomatic patients, atherosclerosis imaging-quantitative computed tomography was performed for total plaque volume (TPV) and percentage atheroma volume, as well as the volume of noncalcified plaque (NCP), calcified plaque, and low-density NCP (LD-NCP), diameter stenosis, and vascular remodeling. This study also included VF analysis and subcutaneous fat analysis, recording of outer waist circumference, and percentage body fat analysis.
Results:
The mean age of the patients was 56.1 [SD 8.5] years, and 84.0% were male. Measures of visceral adiposity (mean [SD, Q1-Q3 thresholds]) included estimated body fat, 28.7% (9.0%, 24.1%-33.0%); VF, 169.8 cm2 (92.3, 102.0-219.0 cm2 ); and subcutaneous fat, 223.6 mm2 (114.2, 142.5-288.0 mm2 ). The Spearman correlation coefficients of VF and plaque volume included TPV 0.22 (p = 0.0074), calcified plaque 0.12 (p = 0.62), NCP 0.25 (p = 0.0023), and LD-NCP 0.37 (p < 0.0001). There was a progression of the median coronary plaque volume for each quartile of VF including TPV (Q1: 19.8, Q2: 48.1, Q3: 86.4, and Q4: 136.6 mm3 [p = 0.0098]), NCP (Q1: 15.7, Q2: 35.4, Q3: 86.4, and Q4: 136.6 mm3 [p = 0.0032]), and LD-NCP (Q1: 0.6, Q2: 0.81, Q3: 2.0, and Q4: 5.0 mm3 [p < 0.0001]).
Conclusions:
These findings demonstrate progression with regard to VF and TPV, NCP volume, and LD-NCP volume. Notably, there was a progression of VF and amount of LD-NCP, which is known to be high risk for future cardiovascular events. A consistent progression may indicate the future utility of VF in CVD risk stratification.
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