Differential association between obesity and coronary artery disease according to the presence of diabetes in a Korean population

Ki-Bum Won; Hyuk-Jae Chang; Hiroyuki Niinuma; Jimin Sung; In-Jeong Cho; Chi-Young Shim; Geu-Ru Hong; Young Jin Kim; Byung-Wook Choi; Namsik Chung

doi:10.1186/1758-5996-6-134

Differential association between obesity and coronary artery disease according to the presence of diabetes in a Korean population

Diabetol Metab Syndr. 2014 Dec 5;6(1):134. doi: 10.1186/1758-5996-6-134. eCollection 2014.

Authors

Ki-Bum Won¹, Hyuk-Jae Chang², Hiroyuki Niinuma³, Jimin Sung⁴, In-Jeong Cho⁵, Chi-Young Shim⁵, Geu-Ru Hong⁵, Young Jin Kim⁶, Byung-Wook Choi⁶, Namsik Chung⁵

Affiliations

¹ Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea ; Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
² Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea ; Severance Biomedical Science Institute, Seoul, Republic of Korea.
³ Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
⁴ Graduate School of Health and Welfare CHA University, Seongnam, Republic of Korea.
⁵ Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea.
⁶ Division of Radiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea.

Abstract

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.

Keywords: Cardiac computed tomographic angiography; Coronary artery disease; Diabetes; Obesity.