Change in Abdominal Obesity & Risk of Coronary Calcification
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Transcript of Change in Abdominal Obesity & Risk of Coronary Calcification
Change in Abdominal Obesity & Change in Abdominal Obesity & Risk of Coronary CalcificationRisk of Coronary Calcification
Siamak Sabour, MD, MSc, DSc, PhD, PostdocClinical Epidemiologist
Persian International Epidemiology Network (PIEPNET)
SCIENTIFIC BACKGROUND
• 1994: M.D, I.R. Iran
• 2004: M.Sc, Clinical Epidemiology, Erasmus MC, The Netherlands
• 2006: D.Sc, Clinical Epidemiology, Erasmus MC, The Netherlands
• 2007: Ph.D, Clinical Epidemiology, UMC Utrecht, The Netherlands
• 2008
• Post doc Cardiovascular Epidemiology
Thomas Jefferson University, Philadelphia, PA, USA
• Post doc Pharmacoepidemiology
University of Pennsylvania, Philadelphia, PA, USA
• 2008 until now
Assistant Prof of Clinical Epidemiology & Medicine
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Introduction
• Obesity is a major health problem in industrialized countries.
• The prevalence of overweight and obesity has increased dramatically in last decades.
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Introduction
• Visceral or abdominal obesity is an important indicator of cardiovascular risk.
• Atherosclerosis is a key factor in the pathogenesis of cardiovascular disease.
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Introduction
• Atherosclerosis in the coronary arteries
(CAC) can be accurately and
reproducibly assessed with Multi-
Detector Computed Tomography (MDCT)
in a non-invasive way.
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Introduction
• CAC is increasingly used as a marker of
disease risk or of subclinical atherosclerosis.
• The presence of CAC is a significant
predictor of subsequent cardiovascular
disease and total mortality.
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Introduction
• Randomized Controlled Trials (RCT) have
indicated that weight loss may benefit levels
of risk factors; however, trials were usually of
modest duration.
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PURPOSE
• To determine the impact of change in
abdominal obesity, as assessed by
change in WHR during 9 years, on risk
of coronary artery calcification (CAC).
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DESIGN
Cohort (longitudinal) study
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SUBJECTS
573 postmenopausal women
selected from a population
based cohort study.
(PROSPECT study)
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METHODS
Data on WHR were collected at
baseline (1993-1997) and follow-up
(2002-2004).
At follow-up, the women underwent a
multi-detector computed tomography
(MDCT) (Philips Mx 8000 IDT16) to
assess coronary artery calcium (CAC). 11Sabour S, MD, MSc, DSc, PhD, Postdoc
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METHODS
The Agatston score was used to quantify
coronary artery calcium.
Logistic regression models were used
to evaluate the relations under study.
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METHODS
Change in WHR was categorized
into four groups:
• Low at baseline - Low at follow-up (Low was defined as below the median)
• High-Low
• Low-High
• High-High
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RESULTS
• Compared to subjects whose WHR
remained below the median of the
distribution at both occasions, those
with a WHR above the median at both
occasions had a 2.7 [95% CI 1.8-4.0]
fold increased risk of CAC.
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RESULTS
• Women whose WHR rose over the 9
year period from below the median to
above the median had a 2.5 [95%CI
1.4-4.5] fold increased risk of CAC.
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Risk factors Mean (SD) _______________________________ Baseline Follow-up (1993-1997) (2002-2004)
P value
Age (year) 57.2 ± 5.2 66.8 ± 5.5Body Mass Index (Kg/ m2 ) 25.6 ± 4.0 26.7 ± 4.4 <0.001Waist circumference (cm) 82.3 ± 9.4 86.1 ±11.2 <0.001Hip circumference (cm) 105.1 ± 8.2 102.1 ± 9.3 <0.001Waist to Hip Ratio 0.78 ± 0.05 0.84 ± 0.07 <0.001Systolic blood pressure (mmHg) 131 ± 19 136 ± 21 <0.001Diastolic blood pressure (mmHg) 78 ± 10 72 ± 9 <0.001Pulse pressure (mmHg) 52 ± 14 64 ± 16 <0.001Cholesterol (mmol/l) (n=95) 5.9 ± 0.9 6.2 ± 1.0 0.078LDL cholesterol (mmol/l) (n=95)
4.0 ± 0.9 4.2 ± 0.9 0.118
HDL cholesterol (mmol/l) (n=95)
1.6 ± 0.4 1.4 ± 0.4 <0.001
Glucose (mmol/l) (n=90) 4.3 ± 0.9 5.6 ± 1.0 <0.001Current smoking (%) 18 11 <0.001Former smoking (%) 37 44 <0.001Hypertension § 140/90 (%) 28 27 0.178Diabetes (%) 1 6 <0.001
General characteristics of study population (n=573)
Low Density Lipoprotein, High Density Lipoprotein§ Based on systolic, diastolic and history of having hypertension in baseline questionnaire
General characteristics of study population (n=573)
Low Density Lipoprotein, High Density Lipoprotein§ Based on systolic, diastolic and history of having hypertension in baseline questionnaire
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Age- adjusted relation between cardiovascular risk factors measured at 1993-1997 (baseline) and measured at 2004-2005 (follow-up) and coronary
calcification measured in 2004-2005
RISK FACTORS CORONARY CALCIFICATION OR (95% CI)
Baseline Follow-up Age * § 1.86 (1.54 – 2.25) 1.88 (1.56 – 2.28) Body Mass Index § 1.09 (0.91 – 1.31) 1.11 (0.93 – 1.32) Waist circumference § 1.20 (1.01 – 1.45) 1.28 (1.07 – 1.53) Hip circumference § 0.99 (0.77 – 1.10) 1.01 (0.93 – 1.10) Waist to Hip Ratio § 1.44 (1.21 – 1.72) 1.54 (1.27 – 1.86) Systolic Blood Pressure § 1.42 (1.16 – 1.74) 1.41 (1.15 – 1.71) Diastolic Blood Pressure § 1.40 (1.15 – 1.70) 1.46 (1.22 – 1.75) Pulse pressure § 1.27 (1.04 – 1.56) 1.22 (1.00 – 1.49) Cholesterol § 1.39 (0.87 – 2.19) 1.06 (0.88 – 1.26) LDL cholesterol § 1.45 (0.91 – 2.31) 1.22 (1.02 – 1.46) HDL cholesterol § 0.88 (0.56 – 1.40) 0.80 (0.65 – 0.97) Glucose § 1.31 (0.78 – 2.21) 1.07 (0.91 – 1.25) Current smoking 2.86 (1.71 – 4.77) 6.17 (2.90 – 13.09) Former smoking 1.03 (0.73 – 1.48) 1.12 (0.79 – 1.60) Hypertension 140/90 (%) 1.58 (1.04 – 2.40) 1.73 (1.07 – 2.81) Diabetes (%) 0.30 ( 0.03 – 2.84) 1.29 (0.60 – 2.74) CAC=coronary artery calcification, LDL= Low Density Lipoprotein, HDL=High Density Lipoprotein
* No adjustment for age, § per standard deviation
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Baseline Follow-up Participants OR (95% CI)
Body Mass Index Model 1 Model 2
Low Low 250 1 1
High Low 22 0.97 (0.39-2.46) 0.83 (0.32-2.12)
Low High 45 1.36 (0.68-2.71) 1.21 (0.60-2.46)
High High 255 1.12 (0.77-1.63) 1.13 (0.80-1.65)
Waist circumferenceLow Low 242 1 1
High Low 50 1.46 (0.70 – 3.04) 1.35 (0.64 – 2.84)
Low High 38 2.15 (1.09 – 4.23) 1.94 (0.97 – 3.86)
High High 235 1.53 (1.04 – 2.26) 1.50 (1.01 – 2.23)
Hip circumference
Low Low 246 1 1
High Low 55 1.17 (0.63 – 2.19) 1.14 (0.60 – 2.15)
Low High 33 1.06 (0.48 – 2.37) 1.05 (0.47 – 2.35)
High High 231 0.95 (0.65 – 1.40) 0.93 (0.63 – 1.38)
Waist to Hip RatioLow Low 227 1 1
High Low 49 1.62 (0.83-3.16) 1.70 (0.87-3.33)
Low High 71 2.48 (1.38-4.46) 2.45 (1.35-4.50)
High High 224 2.65 (1.76-3.99) 2.56 (1.70-3.89)
Risk of coronary calcification in categories of change in obesity markers (BMI, WC, HC and WHR)
Model 1= Adjusted for AgeModel 2= Adjusted for Age and Smoking at baseline.
Risk of coronary calcification in categories of change in obesity markers (BMI, WC, HC and WHR)
Model 1= Adjusted for AgeModel 2= Adjusted for Age and Smoking at baseline.
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CONCLUSION
Persistent abdominal obesity
as well as an
increase in abdominal fat over time
relates to an increased
risk of coronary atherosclerosis. 21Sabour S, MD, MSc, DSc, PhD, Postdoc
Acknowledgments
Prof. Diederick. E. Grobbee, MD, PhD
Prof. Mathias Prokop, MD, PhD
Dr. Yvonne. T. van der Schouw, PhD
Prof. Michiel. L. Bots, MD, PhD
1. Julius Centre, University Medical Centre Utrecht, The Netherlands
2. Radiology Department, University Medical Center Utrecht, The Netherlands
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CONCLUSION
Changes in Waist-to-Hip Ratio (WHR)
relates to an
increased risk of CAC.
However, Body Mass Index (BMI), has no
effect on that.
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