Visceral adiposity and the severity of coronary artery disease in middle-aged subjects with normal waist circumference and its relation with lipocalin-2 and MCP-1.
OBJECTIVE
Visceral adipose tissue has emerged as a key organ contributing to the development of coronary artery disease (CAD). However, defining central obesity by waist circumference (WC) may underestimate visceral adiposity in lean patients. The aim of this study was to investigate the relationship between visceral adiposity and severity of CAD in subjects with normal WC.


METHODS
Among 365 patients with documented CAD, 90 male subjects with normal WC (<90 cm) were selected and their visceral fat areas (VFA) were examined using computed tomography. Lipid profiles and levels of adipokines including lipocalin-2, high molecular weight adiponectin, and monocyte chemoattractant protein (MCP)-1 were measured. Patients were divided into tertiles based on VFA at the L4 vertebra level.


RESULTS
Patients with single-vessel disease had significantly lower VFA than those with multi-vessel disease (P<0.05; 86.0 vs. 97.5 vs. 99.6 cm(2) for single- , double- , and triple-vessel diseases, respectively). Positive association between the extent of CAD and VFA was clearly demonstrated and logistic regression analysis showed that subjects in the upper tertile for VFA had a 4.5-fold higher risk of having multi-vessel disease compared with those in the lowest tertile (P<0.05; odds ratio=4.51; 95% confidence interval=1.10-18.45). Circulating levels of lipocalin-2 and MCP-1 were significantly higher in the upper tertiles of VFA.


CONCLUSIONS
Increased visceral adiposity is significantly associated with the severity of CAD, even in subjects without central obesity as determined by WC measurements. Abnormalities in adipokine regulation may provide a novel mechanistic connection between visceral adiposity and associated cardiovascular complications.
Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
Yong-ho
YH
Lee
Sang-Hak
SH
Lee
Eun Suk
ES
Jung
Jung-Sun
JS
Kim
Chi Young
CY
Shim
Young-Guk
YG
Ko
Donghoon
D
Choi
Yangsoo
Y
Jang
Namsik
N
Chung
Jong-Won
JW
Ha
D000328:Adult; D018932:Chemokine CCL2 / Q000097:blood*; D003324:Coronary Artery Disease / Q000473:pathology*; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D055105:Waist Circumference
D018932:Chemokine CCL2; D054834:Lipocalins