title: Association between visceral adipose tissue area and coronary plaque morphology assessed by CT angiography.
abstract: OBJECTIVE
  We sought to investigate the association between visceral adipose tissue (VAT) with the presence, extent, and characteristics of noncalcified coronary plaques (NCPs) using 64-slice computed tomography angiography (CTA).
  
  
  BACKGROUND
  Although visceral adiposity is associated with cardiovascular events, its association with NCP burden and vulnerability is not well known.
  
  
  METHODS
  The study population consisted of 427 patients (age 67 ± 11 years; 63% men) with proven or suspected coronary artery disease who underwent 64-slice CTA. We assessed the presence and number of NCPs for each patient. The extent of NCP was tested for the difference between high (≥ 2) and low (≤ 1) counts. We further evaluated the vulnerable characteristics of NCPs with positive remodeling (remodeling index >1.05), low CT density (≤ 38 HU), and the presence of adjacent spotty calcium. Plain abdominal scans were also performed to measure the VAT and subcutaneous adipose tissue area.
  
  
  RESULTS
  A total of 260 (61%) patients had identifiable NCPs. Multivariate analyses revealed that increased VAT area (per 1 standard deviation, 58 cm(2)) was significantly associated with both the presence (odds ratio [OR]: 1.68; 95% confidence interval [CI]: 1.28 to 2.22) and extent (OR: 1.31; 95% CI: 1.03 to 1.68) of NCP. Other body composition measures, including subcutaneous adipose tissue area, body mass index, and waist circumference were not significantly associated with either presence or extent of NCP. Increased VAT area was also independently associated with the presence of NCP with positive remodeling (OR: 1.71; 95% CI: 1.18 to 2.53), low CT density (OR: 1.69; 95% CI: 1.17 to 2.47), and adjacent spotty calcium (OR: 1.52; 95% CI: 1.03 to 2.27).
  
  
  CONCLUSIONS
  Increased VAT area was significantly associated with NCP burden and vulnerable characteristics identified by CTA. Our findings may explain the excessive cardiovascular risk in patients with visceral adiposity, and support the potential role of CTA to improve risk stratification in such patients.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ohashi
authors.forename: Hideya
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Jun
authors.initials: J
authors.lastname: Horiguchi
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kitagawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Kunita
authors.forename: Hiroto
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Oka
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Kohno
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000473:pathology; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D050152:Intra-Abdominal Fat / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed