Abstract 13248: Insulin Resistance as a Predictor of Coronary Artery Calcification Progression
Introduction: Obesity, nonalcoholic fatty liver disease (NAFLD) and insulin resistance (IR) may coexist, but it is uncertain whether these conditions contribute independently to atherosclerosis. We tested whether fatty liver, IR and obesity increase coronary artery calcium [CAC] score, a marker of atherosclerosis, independently to cardiovascular risk factors and cardiovascular disease (CVD).
Methods: Data were analyzed from a South Korean occupational cohort of 2244 people who all received abdominal ultrasound measurements of fatty liver and non-enhanced coronary computed tomography for CAC score at baseline and follow up. IR was defined by homeostasis model assessment of IR (HOMA-IR) ≥75th percentile. Odds ratios (ORs) (95% CIs) for the presence of a CAC score >0 were estimated using logistic regression.
Results: There were 621 people with CAC score progression. Traditional risk factor, type 2 diabetes and hypertension were independently associated with CAC progression (OR for DM 1.86 [1.17-2.95]; OR for HTN 1.43[1.04-1.96]). HOMA-IR (OR: Q4 vs Q1 1.73 [1.07-2.78]) was associated with CAC progression independently of all metabolic syndrome features, conventional cardiovascular risk factors, and prior evidence of DM and HTN. Smoking, educational status, excise frequency were not associated with CAC progression. Synergic effect had occurred with insulin resistance and obesity (OR 3.10, [1.10-8.74]) and also with obesity and fatty liver (OR 1.61, [1.03-2.53]) after adjustment of various confounding factors including age, sex, alcohol consumption, smoking status, excise frequency, degree of education, DM, HTN. The combination of presence of IR, fatty liver and obesity was associated with CAC progression (OR 3.15, [2.10-4.73]) with adjustment of age and sex. Although the association was attenuated, the combination still showed significant association after adjustment of various confounding factors (OR 2.69 [1.69-4.27]).
Conclusions: The clustering of NAFLD, obesity and IR, is common and markedly increases the odds of CAC progression, and IR also have effects independently of each other and of confounding factors. The data suggest that treatment for each factor is needed to decrease progression of atherosclerosis.
Author Disclosures: K. Sung: None. E. Cheong: None. J. Lee: None. S. Lee: None.
- © 2015 by American Heart Association, Inc.