The Association of Rate of Weight Gain During Early Adulthood With the Prevalence of Subclinical Coronary Artery Disease in Recently Diagnosed Type 2 Diabetes: The MAXWEL-CAD Study

OBJECTIVE: To investigate the association of the rate of weight gain (Ratemax_wt) between the age of 20 years and the age of maximum lifetime weight gain with indicators of subclinical coronary artery disease (CAD) at the time of diagnosis of type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: We studied 1,724 consecutive Korean subjects aged ≥30 years with recently diagnosed (within 3 months) T2D and one or more cardiovascular risk factors to investigate the association of Ratemax_wt with subclinical CAD. We used 64-slice cardiac computed tomography angiography to evaluate the degree of coronary artery stenosis, multivessel involvement, plaque characteristics, and coronary artery calcium score (CACS). Body weight at age 20 years (Wt20y) was obtained from participant records. Participants recalled their maximum weight (Wtmax) before T2D diagnosis and age at maximum weight (Agemax_wt). The Ratemax_wt was calculated as (Wtmax - Wt20y) / (Agemax_wt - 20 years). RESULTS: The prevalence of coronary artery stenosis (≥50%), multivessel involvement (two or more vessels), plaque characteristics, and CACS ≥100 were 11.4%, 6.6%, 19.7%, and 12.8%, respectively. Mean Wt20y and Wtmax were 60.1 ± 10.5 and 73.0 ± 11.5 kg, respectively. Mean Agemax_wt was 41.3 ± 10.7 years, and Ratemax_wt was 0.59 ± 0.56 kg/year. After adjusting for cardiovascular risk factors, including current BMI, the highest quarter of prior weight gain was significantly associated with coronary artery stenosis, multivessel involvement, and plaque characteristics, particularly mixed and noncalcified plaque. CONCLUSIONS: The findings suggest that a greater rate of prior weight gain may accelerate the development of subclinical vascular complications in patients with newly diagnosed T2D.