Visceral Fat Accumulation in Coronary Artery Disease

ABSTRACT

BACKGROUND: The visceral fat accumulation, an important factor to increase the insulin resistance is known to be associated with coronary artery disease. We investigated the relation between visceral fat accumulation and the coronary artery disease. METHODS: The coronary artery disease (CAD) group included 14 patients (9 men and 5 women) with angina pectoris. All patients had typical chest pain, diagnosed as coronary artery disease with coronary angiogram or treadmill test. The patients with hypertension, hyperlipidemia, non-insulin dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT) and taking any medication known to affect the insulin sensitivity were excluded. The control group included 24 healthy volunteers (11 men and 13 women) who were not taking any medication. We measured the visceral fat area, abdominal subcutaneous fat area, thigh muscle area and the thigh fat area with computed tomography (CT) in both groups. We measured the plasma lipid profile, plasma insulin and glucose level during the oral glucose tolerance test in both groups. RESULTS: There were no differences in the age, sex ratio, body mass index (BMI) and the waist to hip ratio (WHR) between both groups. The total cholesterol and LDL cholesterol were significantly higher in CAD group (p<0.001). The HDL cholesterol was significantly lower in CAD group (p<0.05). The fasting insulin, fasting glucose, area under curve (AUC) of the insulin and glucose, and the insulin to glucose (IG) ratio were significant higher in CAD group (p<0.001). There were significant differences between CAD group and the control group in the visceral fat area (94.2+/-19.1 cm2 vs. 76.5+/-34.3 cm2, p<0.05), thigh fat area (60.2+/-24.8 cm2 vs. 92.6+/-41.0 cm2, p<0.01) and the visceral fat to thigh fat area ratio (VSFTF ratio 1.74+/-0.61 vs. 1.07+/-0.80, p<0.01). The visceral fat area was independently associated with fasting insulin (r=0.661, p<0.01), fasting glucose (r=0.490, p<0.05), the AUC of glucose (r=0.605, p<0.01), HDL cholesterol (r= -0.528, p<0.01) and triglyceride (r=0.483, p<0.05) in control group. After adjustment for visceral fat area, there were still significant differences in the fasting insulin, fasting glucose, AUC of insulin, AUC of glucose and the IG ratio between both groups. CONCLUSION: We observed significant increase in the visceral fat area and VSFTF ratio and decrease in thigh fat area in CAD group compared with age, BMI, WHR matched control group. The insulin resistance was observed in the CAD group. The visceral fat area and VSFTF ratio was associated with cardiovascular risk factors such as low HDL cholesterol and the insulin resistance in control group.