Association between carotid intima-media thickness and index of central fat distribution in middle-aged and elderly Chinese

Conicity index and sex differences in relation to carotid plaque instability in Chinese community residents: Conicity index and carotid plaque

OBJECTIVES

The conicity index (CI), an anthropometric parameter of visceral obesity, has exhibited a strong correlation with the incidence of atherosclerosis and cardiovascular events. This study aimed to explore the relationship between CI and carotid plaque instability, as well as the potential differences between sexes in this context.

METHODS

Our cross-sectional study included a total of 44,248 participants from the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP), all of whom underwent carotid ultrasound for the evaluation of carotid plaque. Multivariate logistics regression analysis and restricted cubic spline (RCS) curves were employed to examine the association between CI and the prevalence of carotid plaques and unstable plaques. A subgroup analysis was conducted to account for potential confounding variables.

RESULTS

Patients belonging to the higher CI quartiles had a greater prevalence of carotid plaque and unstable carotid plaque. After adjusting for confounding factors, each standard deviation (SD) increase in CI was associated with an odds ratio (OR) of 1.06 (95% confidence interval: 1.03-1.08) for carotid plaque and 1.03 (95% confidence interval: 1.00-1.05) for unstable carotid plaque. The RCS analysis revealed an escalating trend in the prevalence of unstable carotid plaque with increasing CI values. However, this observed trend was not evident among female participants. Furthermore, subgroup analysis revealed a more pronounced correlation between CI and carotid plaque instability in individuals with a fasting blood glucose (FBG) of ≥ 7 mmol/L and an unhealthy lifestyle characterized by physical inactivity and current smoking.

CONCLUSIONS

Our findings demonstrated that CI was significantly associated with carotid plaque and recommend CI as a promising indicator for the initial screening of atherosclerotic plaques in the future.

Mediating role of triglyceride-glucose index and its derivatives in the relationship between central obesity and Hashimoto thyroiditis in type 2 diabetes

BACKGROUND

Obesity and insulin resistance (IR) may be risk factors for thyroid disease, but there is no clinical-based consensus on this topic. Therefore, this study aims to evaluate the associations between the triglyceride-glucose index (TyG) and its derivatives and Hashimoto thyroiditis (HT) in type 2 diabetes mellitus (T2DM) patients, and explore the relationships between the central obesity indicators and HT risk to provide a reliable basis for the early prevention of HT.

METHODS

A total of 1071 T2DM patients aged ≥ 20 years were selected from a tertiary hospital in Tianjin, all of them had normal thyroid function (including free triiodothyronine, free thyroxine, total triiodothyronine, total thyroxine, and thyroid-stimulating hormone). HT was assessed via thyroid-associated antibodies and thyroid colour Doppler ultrasound. TyG and its derivatives were measured via IR. Restricted cubic spline (RCS) models, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis were used to explore the correlations and predict HT. Mediation analysis explored the mediating role of TyG and its derivatives in the associations between the central obesity indicators and HT.

RESULTS

RCS models revealed that increases in waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), TyG-WC, TyG-WHR, and TyG-WHtR were associated with increased HT risk. Logistic regression revealed that participants in the fourth quartile of TyG-WC, TyG-WHR, and TyG-WHtR had approximately 3.38 times greater HT risk (odds ratio range: 2.807 to 3.375). ROC analysis revealed that WC, WHtR, WHR, TyG-WC, TyG-WHtR and TyG-WHtR could distinguish the presence of HT. In females, the WHR had the highest predictive power, with an area under the ROC curve of 0.651 (95% confidence interval 0.611-0.691, P < 0.001). Mediation analysis revealed that high IR, as assessed by the TyG-body mass index (TyG-BMI), significantly mediated the effects of WC, WHtR, and WHR on the risk of HT. Among them, the TyG-BMI had the highest proportion of mediating effect of WC on HT risk, reaching 74.08%.

CONCLUSION

IR significantly mediates the increased risk of HT associated with central obesity. In clinical practice, WC, WHtR, WHR, TyG-WC, TyG-WHR, and TyG-WHtR serve as sensitive indicators for predicting HT risk in adult T2DM patients.

Impaired Sensitivity to Thyroid Hormones Is Associated With the Change of Abdominal Fat in Euthyroid Type 2 Diabetes Patients: A Retrospective Cohort Study

Background and Aims: This study is aimed at investigating the potential correlation of thyroid hormone sensitivity with visceral fat area (VFA), subcutaneous fat area (SFA), and body mass index (BMI) among euthyroid type 2 diabetes mellitus (T2DM) subjects. Methods: Thyroid hormone sensitivity indices were calculated by thyroid feedback quantile-based index (TFQI), TSH index (TSHI), thyrotropin thyroxine resistance index (TT4RI), and free thyroxine (fT4)/free triiodothyronine (fT3) ratio. These indices were then categorized into quartiles for analysis. The outcomes were the change rates in VFA, SFA, and BMI among the participants. Result: The present study included 921 patients, with a median follow-up of 2.2 years. In multivariate linear regression, when compared to the first quartile, SFA demonstrated a notable decline in the fourth quartile of TFQI, TSHI, and TT4RI (β coefficient = -5.78, -7.83, and - 6.84 cm2 per year), while it significantly increased in the fourth quartile of fT4/fT3 ratio (β coefficient = 6.13 cm2 per year). Similarly, in the fourth quartile of TFQI, TSHI, and TT4RI, VFA decreased significantly, evidenced by β coefficients of -5.14, -4.80, and -4.08 cm2 per year. Yet, among the quartiles of the fT4/fT3 ratio, no discernible trend in VFA was observed. There was no significant association between indices of thyroid hormone sensitivity and change in BMI. Conclusion: Impaired central sensitivity to thyroid hormones was significantly associated with the reduction of VFA and SFA, while impaired peripheral sensitivity was associated with an increase of SFA in euthyroid individuals with T2DM.

Prevalence and influencing factors of abnormal carotid artery intima-media thickness in Henan Province in China

Background

Carotid intima-media thickness (CIMT) has been shown to be a valuable predictor of cardiovascular diseases (CVDs). The aim of this study was to investigate the influencing factors of CIMT among adults in Central China.

Methods

A total of 2,578 participants who underwent physical examination in Henan Provincial People's Hospital between January 2018 and July 2018 were enrolled. The respondents were divided into two subgroups according to their CIMT value (CIMT ≥1.0 mm group and CIMT <1.0 mm group). Variables considered were age, gender, total cholesterol, triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) triglycerides, fasting blood glucose, and uric acid levels, as well as hypertension, diabetes, body mass index (BMI), waist-to-hip ratio, body fat percentage, and visceral fat area (VFA). Logistic regression analysis was performed to explore the potential factors influencing CIMT.

Results

The proportion of CIMT ≥1.0 mm among the physical examination population was 27.42% (707/2 578). The analysis of the two groups revealed significant differences in age, sex, hypertension, diabetes, total cholesterol, and HDL cholesterol. In the logistic regression analysis, age (OR=1.071, 95%CI=1.062-1.080), male sex (OR=2.012, 95%CI=1.251-2.238), hypertension (OR=1.337, 95%CI=1.031-1.735), diabetes (OR=1.535, 95%CI=1.045-2.255), HDL cholesterol (OR=0.540, 95%CI=0.366-0.796), and LDL cholesterol (OR=1.336, 95%CI=1.154-1.544) were significantly associated with abnormal CIMT.

Conclusion

Early screening should be carried out among men, the older adults, and those with hypertension, diabetes, and dyslipidemia.

Independent Relevance of Different Measures of Adiposity for Carotid Intima-Media Thickness in 40 000 Adults in UK Biobank

Background Uncertainty persists about carotid intima-media thickness (CIMT) as a marker of subclinical atherosclerosis and the independent relevance of different measures of adiposity for CIMT. We assessed the independent relevance of general adiposity (body mass index), central adiposity (waist circumference), and body composition (fat mass index and fat-free mass index) with CIMT among adults in the United Kingdom. Methods and Results Multivariable linear regression of cross-sectional analyses of UK Biobank assessed the mean percentage difference in CIMT associated with equivalent differences in adiposity measures. To assess independent associations, body mass index and waist circumference were mutually adjusted, as were fat mass index and fat-free mass index. Among 39 367 participants (mean [SD] age 64 [8] years, 52% female, 97% White), median (interquartile range) CIMT was 0.65 (0.14) mm in women and 0.69 (0.18) mm in men. All adiposity measures were linearly and positively associated with CIMT after adjusting for confounders. Fat-free mass index was most strongly associated with CIMT after adjustment for fat mass index (% difference in CIMT: 1.23 [95% CI 0.93-1.53] women; 3.44 [3.01-3.86] men), while associations of fat mass index were attenuated after adjustment for fat-free mass index (0.28 [-0.02, 0.58] women; -0.59 [-0.99, -0.18] men). After mutual adjustment, body mass index remained positively associated with CIMT, but waist circumference was completely attenuated. Conclusions Fat-free mass index was the adiposity measure most strongly associated with CIMT, suggesting that CIMT may reflect vascular compensatory remodeling rather than atherosclerosis. Hence, screening for subclinical atherosclerosis should evaluate carotid plaques in addition to CIMT.

Evaluation of risk factors and diseases associated with metabolic and atherosclerotic disorders in different abdominal fat distribution patterns assessed by CT-scan

INTRODUCTION

Obesity is defined as an increase in body fat composition.

Gender-Based Association of Coronary Artery Calcification and Framingham Risk Score With Non-alcoholic Fatty Liver Disease and Abdominal Obesity in Taiwanese Adults, a Cross-Sectional Study

Background

It is not certain whether non-alcoholic fatty liver disease (NAFLD) or abdominal obesity (AO) has stronger associations with atherosclerosis and coronary artery disease (CAD) risk across different genders. The purpose of this study was to determine the gender-based association of NAFLD and AO with subclinical atherosclerosis represented by coronary artery calcification (CAC) and CAD risk by Framingham risk score (FRS).

Methods

A total of 1,655 participants in a health-screening program (mean age: 49.44 years; males: 70.33%) were enrolled for analysis. Fatty liver and coronary artery calcium score (CACS) were measured via ultrasonography (US) and multi-detector computed tomography (MDCT). The presence of CAC was defined as having a CACS > 0, intermediate to high CAD risk was defined as FRS ≥ 10%, while the presence of AO was defined as having a waist circumference (WC) of ≥90 cm for men and ≥80 cm for women. Participants were categorized into four groups depending on the presence or absence of NAFLD and/or AO.

Results

The percentage of subjects with CACS > 0 was highest in the AO-only group (overall: 42.6%; men: 48.4%; women: 35.8%); and FRS ≥ 10% was highest in the group with both abnormalities (overall: 50.3%%; men: 57.3%; women: 32.4%). After adjustment factors, the odds ratio (OR) for CAC and FRS was the highest in the group with both abnormalities [men: 1.61 (1.13–2.30) for CACS > 0 and 5.86 (3.37–10.20) for FRS ≥ 10%; women: 2.17 (1.13–4.16) for CACS > 0 and 6.31 (2.08–19.10) for FRS ≥ 10%]. In men, the OR of NAFLD was higher than that of AO [1.37 (1.03–1.83) vs. 1.35 (1.02–1.79) for CACS > 0, 3.26 (2.13–4.98) vs. 2.97 (1.91–4.62) for FRS ≥ 10%]. However, women with AO consistently showed increased OR for CACS > 0 [1.87 (1.11–3.16)] and FRS ≥ 10% [4.77 (2.01–11.34)].

Conclusion

The degree of association of NAFLD and AO with CAC and FRS depends on the gender. NAFLD is more closely associated with CACS > 0 and FRS ≥ 10% in men and AO in women, respectively. NAFLD and AO could be considered independent determinants of CAC and FRS by gender.

The association of waist-to-height ratio and other anthropometric measurements with subclinical atherosclerosis: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND AND AIMS

To compare the performance of waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist circumference (WC) and Body-mass index (BMI) with subclinical atherosclerosis.

METHODS AND RESULTS

The association of quintiles of anthropometric variables (1st as reference) - Odds ratio (OR); 95% Confidence Interval (95% CI) - with Coronary Artery Calcium (CAC: 0 vs. >0; <100 vs. ≥100), Carotid Intima-Media Thickness (CIMT: <75th vs. ≥P75%) and as continuous variables in linear regression models in 4216 participants of ELSA-Brasil baseline. WHtR was associated with CAC >0 (OR, 1.84; 95% CI, 1.16-2.93) and ≥100 after multivariate adjustment including BMI. WHR was associated with CAC >0 OR, 1.81 (95% CI, 1.25-2.82) and ≥100. BMI was not associated with CAC after further adjustment for WHtR, but was associated with CAC >0 after adjustment for WHR (OR, 1.42; 95% CI, 1.02-1.94) or WC (1.63; 95% CI, 1.03-2.59). WHtR was not associated with CIMT after further adjustment for BMI. WHR was associated with CIMT ≥P75% (OR, 1.44; 95% CI, 1.02-2.02) and in linear models (p < 0.0001). WC was associated with CIMT in linear models (p < 0.0001). BMI was associated to CIMT ≥P75% (OR, 2.25; 95% CI, 1.53-2.54); and in linear models (P < 0.0001) after further adjustment for WHtR. After adjustment for WHR and WC the association of BMI with CIMT ≥P75% was respectively (OR 2.31; 95% CI, 1.70-3.13; and OR 2.39; 95% CI, 1.55-3.70); and in both linear models (p < 0.0001).

CONCLUSIONS

WHtR was a good biomarker for subclinical atherosclerosis measured by CAC while BMI was a good biomarker for CIMT. WHR presented the best performance being associated with both biomarkers of subclinical atherosclerosis.

Visceral adiposity index and cervical arterial atherosclerosis in northeast China: a population based cross-sectional survey

BACKGROUND AND PURPOSE

The burden of cervical arterial atherosclerosis, which is an important risk factor of stroke, is huge in China. The visceral adiposity index (VAI) is a convenient index that is related to a series of metabolic abnormalities and a variety of diseases, including cerebrovascular diseases. This study aimed to explore the relationship between VAI and cervical arterial atherosclerosis.

METHODS

This cross-sectional study used the multistage stratified random cluster sampling method to acquire a representative sample of residents aged ≥40 in the general population of northeast China. All participants completed a detailed questionnaire and provided blood samples. Cervical vascular ultrasound was performed by experienced ultrasound doctors. VAI was calculated by a well-established formula and analyzed by quartiles (Q1-Q4).

RESULTS

A total of 3688 people aged ≥40 years who underwent cervical arterial ultrasound were finally included, amongst whom 3.2% had increased intima-media thickness (IMT), 48.6% had carotid plaque and 4.0% had cervical artery stenosis (CAS). After adjusting for several parameters, little statistical significance was found between VAI and increased IMT; compared with the VAI-Q1 group, the VAI-Q2, VAI-Q3 and VAI-Q4 groups were more likely to have CAS [odds ratio (OR) 2.01, 95% confidence interval (CI) 1.17-3.43; OR 1.82, 95% CI 1.05-3.15; OR 1.79, 95% CI 1.03-3.12] and the VAI-Q3 and VAI-Q4 groups were at greater risk of carotid plaque (OR 1.30, 95% CI 1.05-1.62; OR 1.34, 95% CI 1.07-1.67).

CONCLUSIONS

The VAI was related to carotid plaque and CAS in the general population that is older than 40 years.

Long-term trajectories of BMI predict carotid stiffness and plaque volume in type 2 diabetes older adults: a cohort study

BACKGROUND

High body mass index (BMI) is a risk factor for type 2 diabetes and cardiovascular disease. However, its relationships with indices of carotid stiffness and plaque volume are unclear. We investigated associations of long-term measurements of BMI with indices of carotid stiffness and atherosclerosis among non-demented diabetes patients from the Israel Diabetes and Cognitive Decline (IDCD) study.

METHODS

Carotid ultrasound indices [carotid intima media thickness (cIMT), distensibility, elastography and plaque volume] were assessed in N = 471 participants. Mean BMI across all MHS diabetes registry measurements and trajectories of BMI were calculated. BMI was categorized into three trajectory groups representing: a relatively stable normal weight (n = 185, 44%), overweight trajectory (n = 188, 44.8%) and a trajectory of obesity (n = 47, 11.2%). Linear and logistic regressions estimated associations of carotid indices with mean BMI and BMI trajectories.

RESULTS

Compared to the normal weight trajectory, an obesity trajectory was associated with carotid distensibility (β = - 3.078, p = 0.037), cIMT (β = 0.095, p = 0.004), and carotid elastography (β = 0.181, p = 0.004) but not with plaque volume (β = 0.066, p = 0.858). Compared with the normal weight trajectory, an obesity trajectory was associated with increased odds for impaired carotid distensibility (OR = 2.790, p = 0.033), impaired cIMT (OR = 5.277, p = 0.001) and large carotid plaque volume (OR = 8.456, p = 0.013) but not with carotid elastography (OR = 1.956, p = 0.140). Mean BMI was linearly associated with Distensibility (β = - 0.275, p = 0.005) and cIMT (β = 0.005, p = 0.026).

CONCLUSIONS

Long-term measurements of adiposity are associated with indices of carotid stiffness and plaque volume among older type 2 diabetes adults.

Association of Waist-to-Height Ratio, Metabolic Syndrome, and Carotid Atherosclerosis in Individuals with a High Risk of Stroke: A Cross-Sectional Study of 9605 Study Participants

Background: To determine the association of waist-to-height ratio (WHtR), metabolic syndrome (MetS), and carotid atherosclerosis (CAS) in individuals with a high risk of stroke. Methods: We performed a cross-sectional analysis of 9605 study responders from eight urban area communities in Northern China. Height, weight, waist circumference, blood pressure (BP), and blood lipid were measured. Information of population characteristics, smoking status, alcohol consumption, physical activity, and diet were determined by validated questionnaire. Results: A total of 9605 study responders were included in this study. The average age was 60 ± 9 years with 5911 (61.5%) patients being females. The prevalence of MetS and CAS was 26.2% and 75.1%, respectively. WHtR was significantly associated with CAS using our final adjusted model [odds ratio (OR): 1.233, 95% confidence interval (CI): 1.096-1.378]. The association of CAS with hypertension and hyperglycemia were statistically significant among factors that constitute MetS. Additional risk factors affecting the development of CAS included age, previous stroke, and smoking history (P < 0.05). Conclusion: WHtR was determined to perform better compared with other traditional indicators for correlating CAS. We believe that WHtR is a better indicator for the early identification of CAS in individuals with a high risk of stroke. This will facilitate the early detection and intervention of CAS.

Are Obesity Indices Useful for Detecting Subclinical Atheromatosis in a Middle-Aged Population?

OBJECTIVE

There is a close relationship between excess adiposity and cardiovascular disease. Although body mass index (BMI) is the most used approach to estimate excess weight, other anthropometric indices have been developed to measure total body and abdominal adiposity. Here, our objective was to assess the usefulness of these anthropometric indices to detect subclinical atheromatous disease.

METHODS

A cross-sectional study with 6,809 middle-aged subjects (mean age, 57 [53-63] years) with low to moderate cardiovascular risk from the ILERVAS project. Measures of total body fat (BMI, Clínica Universidad de Navarra - Body Adiposity Estimator [CUN-BAE], and Deurenberg's formula) and central adiposity (waist and neck circumferences, conicity index, waist-to-height ratio, Bonora's equation, the A body adiposity index, and body roundness index) were performed in all participants. Bilateral carotid and femoral ultrasound vascular studies allowed the identification of subjects with plaque. -Results: All measured indices were significantly higher in males with subclinical carotid or femoral plaques (p ≤ 0.021 for all). Also, a positive and significant correlation between all indices and the number of affected territories was found (p ≤ 0.013 for all). From the ROC analysis, all measurements identified patients with asymptomatic atheromatosis but none of them helped make clinical decisions. Regarding females, the results were less conclusive.

CONCLUSION

Obesity indices are related to subclinical atheromatosis, especially in men, in a large cohort of middle-aged subjects. However, the indices could not detect the presence of arterial plaque, so, when used in isolation, are unlikely to be decisive.

Analysis of risk factors for carotid intima-media thickness in patients with type 2 diabetes mellitus in Western China assessed by logistic regression combined with a decision tree model

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with type 2 diabetes (T2DM). Carotid intima-media thickness (CIMT) is considered a preclinical stage of atherosclerosis. Therefore, it is necessary to identify the related risk factors for CIMT to facilitate the early prevention of CVD. Previous studies have shown that visceral fat area (VFA) is a risk factor for T2DM and CVD. However, few studies have focused on the effects of VFA on CIMT associated with T2DM. Moreover, considering that the body fat distribution shows regional and racial heterogeneity, the purpose of this study was to investigate the predictive value of VFA and other risk factors for CIMT associated with T2DM in Western China.

METHODS

In a cross-sectional study, a total of 1372 patients with T2DM were divided into the CIMT (-) group (n = 965) and the CIMT (+) group (n = 407) based on CIMT values. In addition to the univariate analyses, logistic regression analysis and a decision tree model were simultaneously performed to establish a correlation factor model for CIMT.

RESULTS

Univariate analyses showed that sex, smoking status, age, heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), height, weight, body mass index (BMI), waist circumference, hip circumference, waist-hip ratio, VFA, subcutaneous fat area, and the levels of 2-h C-peptide, serum creatinine, urea nitrogen and uric acid were significantly different between the two groups (all p < 0.05). Smoking, increased VFA, female sex and increased BMI were risk factors in the logistic regression analyses (OR = 5.759, OR = 1.364, OR = 2.239, OR = 1.186, respectively). In the decision tree model, smoking was the root node, followed by sex, waist circumference, VFA and chronic kidney disease (CKD) in order of importance.

CONCLUSIONS

In addition to smoking, sex and BMI, VFA has a significant effect on CIMT associated with T2DM in the Chinese Han population in Western China. In addition, the decision tree model could help clinicians make more effective decisions, with its simplicity and intuitiveness, making it worth promoting in future medical research.Trial registration ChiCTR, ChiCTR1900027739. Registered 24 November 2019-Retrospectively registered, http://www.chictr.org.cn/index.aspx.

Anthropometric Obesity Indices were Stronger than CT-Based Indices in Associations with Carotid Intima-Media Thickness in Japanese Men

AIM

Computed tomography (CT) can directly provide information on body compositions and distributions, compared to anthropometric indices. It has been shown that various obesity indices are associated with carotid intima-media thickness (IMT). However, whether CT-based obesity indices are stronger than anthropometric indices in association with atherosclerosis remains to be determined in a general population.

METHODS

We cross-sectionally assessed carotid IMT using ultrasound in 944 community-dwelling Japanese men free of stroke and myocardial infarction. CT image at the L4-L5 level was obtained to compute areas of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Anthropometric measures assessed included body mass index (BMI), waist circumference, and waist-to-hip ratio. Using multivariable linear regression, slopes of IMT per 20^th to 80^th percentile of each index were compared. We also compared the slope of index with simultaneous adjustment for BMI in the same model.

RESULTS

Areas of VAT and SAT were positively associated with IMT, but not stronger than those of anthropometric indices in point estimates. Among all obesity indices, BMI was strongest in association with IMT after adjusting for age and lifestyle factors or further adjusting for metabolic factors. In simultaneous adjustment models, BMI, but not CT-based indices, remained significant and showed the strongest association.

CONCLUSIONS

In community-dwelling Japanese men, anthropometric obesity indices, BMI in particular, were more strongly associated with carotid atherosclerosis than CT-based obesity indices. The association of general obesity with carotid atherosclerosis was strong and adding CT-based obesity measure did not considerably influence in the association.

Association between Obesity and Carotid Intima-Media Thickness in Korean Office Workers: The Mediating Effect of Physical Activity

BACKGROUND

Obesity and physical inactivity are associated with higher prevalence of cardiovascular disease (CVD).

OBJECTIVE

This study investigated the association between obesity and carotid intima-media thickness (CIMT) stratified by physical activity (PA) in Korean office workers.

METHODS

Data obtained from 914 office workers aged 21-60 years (347 women) were used. Resting blood pressures, body mass index (BMI), and waist-to-height ratio (WHtR) were measured. PA was assessed using the international physical activity questionnaire. CIMT was assessed with a carotid artery ultrasonography. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of obesity stratified by weekly PA for an abnormally increased CIMT.

RESULTS

Logistic regression analyses showed that those who were overall obese (OR=2.50, 95% CI=1.60-3.91, P<0.001) or central obese (OR=2.08, 95% CI=1.29-3.40, P=0.003) had significantly higher estimated risks of having an abnormally increased CIMT even after adjustments for age, sex, smoking, alcohol consumption, resting blood pressures, and history of hypertension, diabetes, and hyperlipidemia, as compared with those who were not overall or central obese (OR=1). A multivariate linear regression suggested that age (P<0.001), sex (P=0.002), hypertension (P=0.014), smoking (P=0.054), BMI (P<0.001), and physical activity (P=0.011) were important determinants of abnormally elevated CIMT in this study population.

CONCLUSION

The current findings suggest that the risk of obesity for an abnormally increased CIMT is significantly modulated by demographics as well as lifestyle-related risk factors including smoking and physical inactivity in Korean office workers.

Association between atherosclerosis and handgrip strength in non-hypertensive populations in India and Japan

Aim

Although several risk factors contribute to the development of sarcopenia, whether preclinical atherosclerosis contributes to the risk of sarcopenia is not established. The present cross‐sectional study aimed to investigate if there is an association between preclinical atherosclerosis and muscle strength among two ethnic populations.

Methods

Participants included individuals aged ≥40 years and enrolled in the third follow‐up examination of the Andhra Pradesh Children and Parents Study, India, and in the baseline assessments of the Nagasaki Islands Study, Japan. Preclinical atherosclerosis was evaluated by carotid intima‐media thickness, brachial‐ankle pulse wave velocity, cardio‐ankle vascular index. The association of carotid intima‐media thickness and pulse wave velocity/cardio‐ankle vascular index with handgrip strength (HGS) was analyzed separately in the sexes and for hypertensive status from the two cohorts using a multivariable linear regression model.

Results

Data on a total of 1501 participants in India and 3136 participants in Japan were analyzed. Carotid intima‐media thickness was negatively associated with HGS in non‐hypertensive Indian men (B coefficient = −5.38, P = 0.036). Arterial stiffness was also associated with HGS in non‐hypertensive Indian men (B = −0.97, P = 0.001), but not in hypertensive Indian men. Same as Indian men, we found the significant associations between arterial stiffness and HGS in non‐hypertensive women in both India and Japan (B = −0.44, P = 0.020, B = −0.63, P = 0.016, respectively), but not in hypertensive women.

Conclusions

The negative association between preclinical atherosclerosis and HGS was dominantly found in non‐hypertensive participants. Geriatr Gerontol Int 2018; 18: 1071–1078.

The impact of fat distribution on subclinical coronary atherosclerosis in middle-aged Chinese adults

BACKGROUND

The relationship between obesity and cardiovascular disease (CVD) depends not only on the amount of body fat but also on its distribution, which has not been fully investigated in Chinese populations. We aimed to compare measures of fat accumulation in associations with subclinical coronary atherosclerosis in middle-aged Chinese adults.

METHODS

A total of 548 participants aged 40-60years without previous history or clinical symptoms of CVD were randomly selected to undergo abdominal computed tomography (CT) scanning and coronary CT angiography for the evaluation of subcutaneous and visceral fat accumulation and coronary atherosclerosis, respectively. γ-glutamyltranspeptidase (GGT) was used as a surrogate indicator of liver fat accumulation.

RESULTS

Measures of obesity such as body-mass index (BMI), waist circumference, visceral fat areas, and GGT levels, but not subcutaneous fat areas increased substantially across groups of participants without coronary stenosis, with <50% stenosis, and with significant (≥50%) stenosis after adjustment for age and sex. The multivariable multinomial logistic regression analysis showed that most obesity indicators such as BMI, waist circumference, visceral fat areas, and GGT levels were significantly associated with risks of having <50% coronary stenosis after adjustment for conventional cardiovascular risk factors. However, only GGT levels were significantly associated with risks of having significant (≥50%) coronary stenosis after adjustment. In addition, no significant associations were found between measures of fat accumulation and coronary calcification.

CONCLUSIONS

Liver fat accumulation might be more important in the association with subclinical coronary atherosclerosis compared with general and abdominal fat accumulation.

The relationship between distribution of body fat mass and carotid artery intima-media thickness in Korean older adults

[Purpose] The aim of this study was to examine the relationships between the amount and distribution of body fat and the carotid intima-media thickness to explore whether coronary artery disease risk may be mediated through effects on the amount of fat mass in older adults. [Subjects and Methods] A total of 200 elderly females was participated. The percentage of body fat mass was measured by the bioelectrical impedance analysis method, and the carotid intima-media thickness was measured by B-mode ultrasound. Analysis of covariance was performed to assess independent associations between the four categories of percentage of body fat mass and the carotid intima-media thickness after multivariate adjustment. Logistic regression analyses were utilized to calculate odds ratios and 95% confidence intervals for examining independent associations between percentage of body fat mass and the estimated risk of coronary artery disease. [Results] Analysis of covariance showed that the carotid intima-media thickness was significantly thick in both obesity and overweight groups. When multivariate-adjusted OR for the estimated risk of coronary artery disease, the odds ratios for the obesity and overweight groups were 3.0 (95% confidence interval, 1.1 to 8.7) and 2.5 (95% confidence interval, 1.0 to 6.1), respectively. [Conclusion] This study demonstrates that elderly females with a high body fat mass are more likely to have the estimated risk of CAD than who fit body fat mass in elderly female.

High visceral fat with low subcutaneous fat accumulation as a determinant of atherosclerosis in patients with type 2 diabetes

Background

Abdominal visceral obesity has been reported to be associated with cardiovascular risks than body mass index, waist circumference, and abdominal subcutaneous fat. On the other hand, there is evidence that subcutaneous fat has a beneficial role against cardio-metabolic risks such as diabetes or dyslipidemia. However, little is known regarding the association between high visceral fat with low subcutaneous fat accumulation and the risk for atherosclerosis.

Methods

This study was designed to elucidate whether high visceral fat with low subcutaneous fat accumulation enhances the risk for atherosclerosis in patients with type 2 diabetes. This is a cross-sectional study of 148 patients with type 2 diabetes (mean age 65 ± 12 years; 44.5 % female). Visceral fat area (VFA, cm²) and subcutaneous fat area (SFA, cm²) were assessed by abdominal computed tomography. Carotid intima media thickness (CIMT, mm) measured by ultrasonography was used for the assessment of atherosclerosis. Patients were divided into four groups: SFA < 100 cm² and VFA < 100 cm² [S(−)V(−)], SFA ≥ 100 cm² and VFA < 100 cm² [S(+)V(−)], SFA < 100 cm² and VFA ≥ 100 cm² [S(−)V(+)], and SFA ≥ 100 cm² and VFA ≥ 100 cm² [S(+)V(+)]. Linear regression analysis with a stepwise procedure was used for the statistical analyses.

Results

Among the patients examined, 16.3 % were S(−)V(+). Mean (95 % confidence interval) of CIMT adjusting for age and gender were 0.80 (0.69–0.91), 0.86 (0.72–1.01), 1.28 (1.11–1.44) and 0.83 (0.77–0.88) in patients with S(−)V(−), S(+)V(−), S(−)V(+) and S(+)V(+), respectively (p < 0.001). The S(−)V(+) patients exhibited significantly older than S(−)V(−) patients and those with S(+)V(+) and had a highest VFA-SFA ratio (V/S ratio) among the four groups. S(−)V(+) patients were male predominant (100 % male), and S(+)V(−) patients showed female predominance (82 % female). In multivariate linear regression analysis (Adjusted R² = 0.549), S(−)V(+) was significantly associated with CIMT (Standardized β 0.423, p < 0.001). Notably, S(+)V(+) was inversely associated with CIMT in the multivariate model.

Conclusions

This study provides evidence that high visceral fat with low subcutaneous fat accumulation is an important determinant of carotid atherosclerosis and high subcutaneous fat could be protective against atherosclerosis in patients with type 2 diabetes.

Higher association of coronary artery calcification with non-alcoholic fatty liver disease than with abdominal obesity in middle-aged Korean men: the Kangbuk Samsung Health Study

BACKGROUND

It is uncertain whether non-alcoholic fatty liver disease (NAFLD) or abdominal obesity is more associated with atherosclerosis. The aim of this study was to determine whether NAFLD or abdominal obesity is more strongly associated with subclinical atherosclerosis represented by coronary artery calcification (CAC).

METHODS

A total of 21,335 male participants in a health screening program (mean age 41 years) were enrolled. Ultrasonographic measurements of fatty liver and multi-detector computed tomography were performed to determine the coronary artery calcium score (CACS). The presence of CAC was defined as CACS > 0. Subjects were divided into four groups according to the presence or absence of NAFLD and/or abdominal obesity as assessed by waist-hip ratio (WHR) > 0.9.

RESULTS

The presence of CAC was detected in 2,385 subjects (11.2%). The proportion of subjects with CAC was highest in the abdominal obesity only group (23.2%). After adjustment for age, diabetes history, hypertension, cigarette smoking, and physical inactivity, the odds ratio (OR) for CAC was the highest in the group with both abnormalities [1.465 (1.324-1.623)]. The NAFLD only group showed significantly increased OR for CAC compared to that in the abdominal obesity only group [1.286 (1.151-1.436) vs. 1.076 (0.939-1.233)].

CONCLUSION

Non-alcoholic fatty liver disease is more closely associated with CAC than abdominal obesity as assessed by the WHR. NAFLD could be considered an independent determinant of subclinical atherosclerosis as assessed by CAC.

Association of hemoglobin A1c and glycated albumin with carotid atherosclerosis in community-dwelling Japanese subjects: the Hisayama Study

Background

It is not clear which glucose measure is more useful in the assessment of atherosclerosis. We investigated the associations of hemoglobin A_1c (HbA_1c), glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), fasting plasma glucose (FPG), and 2-hour postload glucose (PG) with carotid intima-media thickness (IMT) in community-dwelling Japanese subjects.

Methods

A total of 2702 subjects aged 40–79 years underwent a 75-g oral glucose tolerance test and measurements of HbA_1c, GA, 1,5-AG, and carotid IMT by ultrasonography in 2007–2008. Carotid wall thickening was defined as a maximum IMT of >1.0 mm. The crude and multivariable-adjusted linear and logistic regression models were used to analyze cross-sectional associations between levels of glycemic measures and carotid IMT.

Results

The crude average of the maximum IMT increased significantly with rising quartiles of HbA_1c, GA, FPG, and 2-hour PG levels in subjects with and without glucose intolerance (GI), while no clear association was observed for 1,5-AG. After adjustment for other confounding factors, positive trends for HbA_1c, GA, and FPG (all p for trend < 0.05), but not 2-hour PG (p = 0.07) remained robust in subjects with GI, but no such associations were found in those without GI. When estimating multivariable-adjusted β values for the associations of 1 SD change in glycemic measures with the maximum IMT in subjects with GI, the magnitude of the influence of HbA_1c (β = 0.021), GA (β = 0.024), and FPG (β = 0.024) was larger than that of 2-hour PG (β = 0.014) and 1,5-AG (β = 0.003). The multivariable-adjusted odds ratios for the presence of carotid wall thickening increased significantly with elevating HbA_1c, GA, and FPG levels only in subjects with GI (all p for trend < 0.001). Among subjects with GI, the area under the receiver operating characteristic curve significantly increased by adding HbA_1c (p = 0.04) or GA (p = 0.04), but not 1,5-AG, FPG, or 2-hour PG, to the model including other cardiovascular risk factors.

Conclusions

In community-dwelling Japanese subjects with GI, elevated HbA_1c, GA, and FPG levels were significantly associated with increased carotid IMT, and HbA_1c and GA provided superior discrimination for carotid wall thickening compared to 1,5-AG, FPG, and 2-hour PG, suggesting that HbA_1c and GA are useful for assessing carotid atherosclerosis.

Electronic supplementary material

The online version of this article (doi:10.1186/s12933-015-0247-7) contains supplementary material, which is available to authorized users.

Normal-weight obesity is associated with increased risk of subclinical atherosclerosis

BACKGROUND

Subjects with normal body mass index (BMI) but elevated amounts of body fat (normal-weight obesity; NWO) show cardiometabolic dysregulation compared to subjects with normal BMI and normal amounts of body fat (normal-weight lean; NWL). In this study, we aimed to evaluate whether NWO individuals have higher rates of subclinical atherosclerosis compared to NWL subjects.

METHODS

From a large-scale health checkup system, we identified 2078 normal weight (18.5 ≤ BMI < 25 kg/m(2)) subjects with no previous history of coronary artery disease who underwent analysis of atherosclerosis using coronary computed tomography angiography (CCTA) and pulse wave velocity (PWV). NWO was defined as normal BMI and highest tertile of body fat percentage by sex (men ≥ 25. 4 % and women ≥ 31.4 %). CCTA was performed using a 64-detector row CT. A plaque was defined as a structure >1 mm(2) within and/or adjacent to the vessel lumen and classified according to the presence/proportion of intraplaque calcification.

RESULTS

NWO subjects (n = 283) demonstrated metabolic dysregulation compared to NWL individuals (n = 1795). After adjusting for age, sex, and smoking, NWO individuals showed higher PWV values than NWL individuals (1474.0 ± 275.4 vs. 1380.7 ± 234.3 cm/s, p = 0.006 by ANCOVA). Compared with NWL subjects, NWO subjects had a higher prevalence of soft plaques even after age, sex, and smoking adjustment (21.6% vs. 14.5%, p = 0.039 by ANCOVA). The PWV value and the log{(number of segments with plaque) + 1} showed a positive correlation with numerous parameters such as age, systolic blood pressure, visceral fat, fasting glucose level, serum triglyceride level, and C-reactive protein (CRP) in contrast to the negative correlation with high-density lipoprotein-cholesterol level. The visceral fat was an independent determinant of log{(number of segments with plaque) + 1} (ß = 0.027, SE = 0.011, p = 0.016) even after adjustment for other significant factors. Most importantly, NWO was an independent risk factor for the presence of soft plaques (odds ratio 1.460, 95 % confidence interval 1.027-2.074, p = 0.035) even after further adjustment for multiple factors associated with atherosclerosis (blood pressure, blood glucose, lipid level, CRP, medication, smoking status, physical activity).

CONCLUSIONS

NWO individuals carry a higher incidence of subclinical atherosclerosis compared with NWL individuals, regardless of other clinical risk factors for atherosclerosis.