Key result
Obesity is linked to ~14% greater risk of coronary plaque and severe calcification in non-diabetics.
Why the study?
The association between obesity and coronary artery disease according to diabetes status in an Asian population, where most diabetic subjects are non-obese, was unclear.
Is obesity associated with an increased risk of coronary artery disease differently in diabetic versus non-diabetic patients?
Cross-Sectional (n=7,234)
No
Is obesity associated with an increased risk of coronary artery disease differently in diabetic versus non-diabetic patients?
Obesity is associated with the presence of coronary plaque and severe calcification in non-diabetic individuals, but this association is not observed in diabetic patients, where diabetes itself is the dominant risk factor.
Obesity may heighten CAD plaque risk only without diabetes; leaves open interaction and needs prospective confirmation.
BACKGROUND: Coronary artery disease (CAD) is a major cardiovascular complication in diabetic patients. Despite the significant association between obesity and diabetes, the majority of the diabetic subjects are not obese in an Asian population. This study evaluated the association between obesity and coronary artery disease (CAD) according to the diabetes status in a Korean population. METHODS: The association between obesity and CAD using the parameters of any plaque, obstructive plaque, and coronary artery calcium score (CACS) >100 according to the presence of diabetes was evaluated in 7,234 Korean adults who underwent multi-detector computed tomography for general health evaluations. Obesity was defined as a body mass index (BMI) ≥25 kg/m(2). RESULTS: The prevalence of obesity was significantly higher in diabetic subjects than in non-diabetic subjects, but the majority of the diabetic subjects were non-obese (48% vs. 37%, p <0.001). The incidence of any plaque (58% vs. 29%), obstructive plaque (20% vs. 6%), and CACS >100 (20% vs. 6%) were significantly higher in diabetic patients than in non-diabetic subjects (p <0.001, respectively). Incidence of any plaque (33% vs. 26%, p <0.001), obstructive plaque (7% vs. 6%, p = 0.014), and CACS >100 (8% vs. 6%, p = 0.002) was significantly higher in non-diabetic subjects with obesity than in those without obesity, but the incidence of all coronary parameters was not different in diabetic subjects according to the obesity status. After adjusting for confounding risk factors including age, gender, hypertension, dyslipidemia, current smoking, and mild renal dysfunction, obesity was independently associated with increased risks of any plaque (OR 1.14) and CACS >100 (OR 1.31) only in non-diabetic subjects (p <0.05, respectively). Multiple logistic regression models revealed that diabetes was independently associated with all coronary parameters. CONCLUSION: Despite a significantly higher prevalence of obesity in diabetic subjects than in non-diabetic subjects, obesity is associated with the presence of any plaque and severe coronary calcification only in subjects without established diabetes among Korean population.
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Won et al. (2014) conducted a cross-sectional in Coronary artery disease (n=7,234). Obesity vs. Non-obesity was evaluated on Presence of any coronary plaque in non-diabetic subjects (OR 1.14, 95% CI 1.01-1.30, p=0.039). Obesity was independently associated with an increased risk of any coronary plaque (OR 1.14) and severe coronary calcification only in subjects without established diabetes.
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