Abstract 1623: Quantification of Visceral Adipose Tissue Adds Value to BMI and Metabolic Syndrome in Prediction of Subclinical Atherosclerosis in Men With Type 2 Diabetes
Background: Adiposity, particularly visceral adipose tissue, has been shown to independently predict atherosclerosis in non-diabetics. However, the role of adipose tissue distribution has not been studied in type 2 diabetes (T2D) adjusting for conventional risk factors. We sought to understand the relationship between adipose tissue distribution and subclinical atherosclerosis (SA) in T2D patients.
Methods: We examined 375 patients with T2D (age 58±9 years, 50.4% male, 66% white). Adiposity measurements included body mass index (BMI) and computed tomography of the abdomen (L4 level). Visceral adiposity (VAT), subcutaneous adiposity (SAT) & total adipose tissue (TAT) were expressed as area (mm2) by a single-reader; V:T was calculated as a ratio of VAT:TAT. Global Coronary artery calcification scores (CAC) were based on Agatston scoring analyzed by a single reader. Framingham risk scores (FRS) were calculated based on total cholesterol values. Statistical analysis was performed (STATA 10). Given gender based differences in adipose tissue distribution, all analyses were stratified by gender.
Results: There was significant SA in this T2D sample (CAC: mean 290, median 26). In age & race adjusted models in men but not in women VAT (p=0.003) & V:T (p=0.027) were associated with increasing CAC. The association in men continued to be significant after adjusted for traditional risk factors (FRS, alcohol use, smoking, exercise) (VAT, p=0.007 & V:T, p=0.041) and then BMI (VAT, p=0.005 & V:T, p=0.038) & NCEP-defined metabolic syndrome (METSYN) (VAT, p=0.0016 & V:T, p=0.044). Interaction analysis in models adjusted for medications, risk factors, BMI & METSYN showed a significant gender difference in CAC by VAT (p=0.032) & V:T (p=0.012). In fully adjusted nested models, VAT & V:T added value to CAC prediction in presence of BMI (VAT, LRT chi2=3.85 & p=0.049; V:T, LRT chi2=4.34 & p=0.037) and METSYN (VAT, LRT chi2=5.87 & p=0.015; V:T, LRT chi2=4.10 & p=0.042) which did not predict CAC in the presence of VAT and V:T.
Conclusions: In this T2D patient sample, we found a significant gender difference in VAT and V:T in predicting CAC. This relationship was independent of traditional risk factors and added incremental value to prediction of CAC beyond BMI & METSYN.