title: Visceral abdominal fat accumulation predicts the progression of noncalcified coronary plaque.
abstract: BACKGROUND
  Excess visceral abdominal tissue (VAT) is more strongly associated with risk factors of coronary artery disease (CAD) than body mass index (BMI) or waist circumference. However, whether adding VAT measurements to CAD risk factors provides better risk assessment for CAD progression has not been fully evaluated.
  
  
  RESULTS
  This prospective cohort study comprised 553 CAD patients with coronary plaque with ≤50% coronary stenosis as assessed by computed tomography (CT) angiography. Quantification of VAT area was performed together with CT angiography using abdominal CT scanning. After a mean 38±8 months follow-up, 320 patients underwent repeated CT scans for worsening angina symptoms without findings of positive ischemia. Increased segments of noncalcified plaque were seen in 152 (48%) and an increased calcium score was seen in 261 (82%) patients. The risk for progression of noncalcified plaque increased steadily with higher VAT quartiles, independent of CAD risk factors. Patients in the higher quartiles were at increased risk of progression of noncalcified plaque (quartiles IV OR 4.7; 95% CI 2.3-9.4, p-value<0.001). In contrast, increases above the median calcium score showed no independent correlation to VAT. Compared to VAT, progression of noncalcified plaque showed no phased increase with higher waist circumference and weaker increase with higher BMI quartiles.
  
  
  CONCLUSIONS
  VAT accumulation was positively associated with progression of coronary noncalcified plaque, but not of calcified plaque. This suggests that risk assessment of progression of noncalcified plaque can be improved by combining VAT measurements and CAD risk factors.
authors.affiliation: Cardiovascular Center, Amagasaki Central Hospital, Hyogo, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Imai
authors.forename: Sei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ohara
authors.forename: Teruaki
authors.initials: T
authors.lastname: Kamata
authors.forename: Jyunichi
authors.initials: J
authors.lastname: Yoshida
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Miyaji
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Takewa
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Kodama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000473:pathology*; D007564:Japan; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000473:pathology; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed