title: Visceral fat and coronary artery calcification in patients with chronic kidney disease.
abstract: BACKGROUND
  Abdominal fat is a metabolically active tissue which has been associated with cardiovascular events and death in chronic kidney disease (CKD) patients. We explore here the association between surrogates of abdominal fat and coronary artery calcium score (CACs).
  
  
  METHODS
  Cross-sectional analysis of 232 non-dialysis-dependent CKD patients Stages 3-5 (median age 60 [25th-75th percentile 52-67] years; 60% men). Visceral adipose tissue (VAT) and CACs were assessed by computed tomography. Surrogates of abdominal fat included VAT and waist circumference (WC).
  
  
  RESULTS
  VAT was positively associated with CACs in univariate analysis (ρ = 0.23). Across increasing VAT quartiles, patients were older, more often men and smokers. Although increasing VAT quartiles associated with higher glomerular filtration rate and leptin, better nutritional status (subjective global assessment) as well as larger muscle stores and strength, they were also more insulin resistant (HOMA-IR), dyslipidemic and inflamed (C-reactive protein and white blood cells). In addition, CACs were incrementally higher. Clinically evident coronary artery calcification (CACs ≥ 10 Agatston) was present in 63% of the patients. Both increased visceral fat (odd ratio 1.60 [95% CI 1.23-2.09] per standard deviation increase) and increased WC (1.05 [1.01-1.12] per cm increase), augmented the odds to present calcification. Such associations remained statistically significant after extensive multivariate adjustment for confounders.
  
  
  CONCLUSIONS
  Abdominal fat is associated with coronary artery calcification in non-dialysis dependent CKD patients, supporting its potential role as a cardiovascular risk factor in uremia.
authors.affiliation: Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Cordeiro
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Fernanda Cassullo
authors.initials: FC
authors.lastname: Amparo
authors.forename: Antonio
authors.initials: A
authors.lastname: Tito-Paladino-Filho
authors.forename: Marcela
authors.initials: M
authors.lastname: Perini
authors.forename: Fernanda Silvestre
authors.initials: FS
authors.lastname: Lourenço
authors.forename: Ibraim Masciarelli Francisco
authors.initials: IM
authors.lastname: Pinto
authors.forename: Celso
authors.initials: C
authors.lastname: Amodeo
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Carrero
mesh_terms: D050153:Abdominal Fat; D000368:Aged; D002114:Calcinosis / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D014057:Tomography, X-Ray Computed; D055105:Waist Circumference
keywords: adiposity; atherosclerosis; central obesity; malnutrition; wasting