Association of Periaortic Fat and Abdominal Visceral Fat with Coronary Artery Atherosclerosis in Chinese Middle Aged and Elderly Patients Undergoing Computed Tomography Coronary Angiography

Jingqi Zhu; Zhangwei Yang; Xiaolin Li; Xiaoli Chen; Jingjiang Pi; Tao Zhuang; Jie Liu; Gang Li; Sheng Peng; Lin Zhang; Qi Zhang; Paul Chan; Brian Tomlinson; Huimin Fan; Liang Zheng; Zhongmin Liu; Yuzhen Zhang

doi:10.5334/gh.1078

Association of Periaortic Fat and Abdominal Visceral Fat with Coronary Artery Atherosclerosis in Chinese Middle Aged and Elderly Patients Undergoing Computed Tomography Coronary Angiography

Volume 16 (2021): Issue 1

By: Jingqi Zhu, Zhangwei Yang, Xiaolin Li, Xiaoli Chen, Jingjiang Pi, Tao Zhuang, Jie Liu, Gang Li, Sheng Peng, Lin Zhang, Qi Zhang, Paul Chan, Brian Tomlinson, Huimin Fan, Liang Zheng, Zhongmin Liu and Yuzhen Zhang

Open Access

|Oct 2021

Figures & Tables

Table 1

The ectopic fat distribution and coronary artery atherosclerosis in participants stratified by age and gender.

Age, years	50–59 (n = 175)	60–69 (n = 388)	70–79 (n = 161)	≥ 80 (n = 26)
CAD-CA, % (n)
Male (378)	54.5 (55)	70.2 (134)**	80.0 (60)**	90.9 (10)**
Female (372)	27.0 (20)	41.6 (82)**	65.1 (56)**	80.0 (12)**
Total (750)	42.9 (75)	55.7 (216)**	72.0 (116)**	84.6 (22)**
CAD-msCA, % (n)
Male (378)	20.8 (21)	34.0 (65)**	49.3 (37)**	54.5 (6)**
Female (372)	5.4 (4)	12.2 (24)*	16.3 (13)*	33.3 (5)*
Total (750)	14.2 (25)	22.9 (89)*	31.7 (51)**	42.3 (11)**
CAC score
Male (378)	47.4 (13–81)	191.4 (117–265)**	355.7 (167–543)**	731.0 (131–1330)**
Female (372)	2.0 (0.6–4.6)	31.2 (15–46)*	159.7 (43–276)**	163.2 (18–344)**
Total (750)	28.2 (8.6–47)	110.0 (71–148)*	251.0 (143–358)**	403.3 (129–677)**
BMI, kg/m²
Male (378)	25.3 (24.6–26.0)	25.2 (24.7–25.6)	24.6 (23.9–25.3)	23.1 (21.1–25.1)*
Female (372)	23.8 (23.0–24.6)	24.5 (24.0–24.9)	23.7 (23.0–24.5)	24.3 (22.4–26.2)
Total (750)	24.7 (24.1–25.8)	24.8 (24.5–25.1)	24.1 (23.6–24.6)	23.8 (22.5–25.1)
WC, cm
Male (378)	92.5 (90.5–94.4)	91.0 (89.7–92.3)	89.5 (87.5–91.6)*	85.3 (77.9–92.7)
Female (372)	86.9 (84.9–88.8)	90.2 (88.8–91.6)*	91.1 (88.5–93.7)**	90.9 (86.1–95.6)
Total (750)	90.1 (88.6–91.5)	90.6 (89.7–91.5)	90.4 (88.7–92.1)	88.5 (84.5–92.5)
VATA, cm²
Male (378)	145.0 (132–157)	146.0 (137–154)	139.2 (125–152)	115.2 (77–152)
Female (372)	100.5 (91–109)	111.8 (105–117)*	124.4 (115–133)**	136.6 (106–166)**
Total (750)	125.7 (117–134)	128.4 (122–133)	131.2 (123–139)	127.5 (102–152)
SATA, cm²
Male (378)	164.0 (151–176)	158.5 (149–167)	148.3 (133–163)*	116.2 (77–155)
Female (372)	207.2 (179–235)	223.0 (211–234)	214.4 (196–232)	194.0 (153–234)
Total (750)	182.7 (168–197)	191.6 (183–199)	184.1 (171–197)	161.2 (128–194)
VATV, cm³
Male (378)	2832 (2552–3112)	2688 (2501–2876)	2504 (2250–2759)	2177 (1201–3054)
Female (372)	1730 (1534–1926)	2128 (1981–2275)*	2208 (1966–2451)*	2170 (1815–2525)*
Total (750)	2354 (2156–2533)	2400 (2278–2521)	2344 (2169–2519)	2173 (1694–2652)
SATV, cm³
Male (378)	2150 (1937–2363)	1911 (1778–2044)	1980 (1666–2294)	1345 (826–1863)
Female (372)	2392 (2087–2697)	2843 (2542–3144)	2456 (2218–2694)	1976 (1566–2386)
Total (750)	2255 (2077–2434)	2391 (2217–2566)	2238 (2043–2433)	1709 (1384–2034)
LSR
Male (378)	1.22 (1.17–1.27)	1.21 (1.17–1.25)	1.27 (1.23–1.31)*	1.39 (1.30–1.49)
Female (372)	1.25 (1.19–1.30)	1.26 (1.23–1.30)	1.33 (1.28–1.38)*	1.29 (1.19–1.39)
Total (750)	1.23 (1.19–1.27)	1.24 (1.21–1.26)	1.30 (1.27–1.34)**	1.33 (1.26–1.40)*
PAFV, cm³
Male (378)	22.2 (19.7–24.6)	23.0 (21.5–24.4)	21.8 (19.6–23.9)	20.2 (12.1–28.2)
Female (372)	10.3 (9.1–11.5)	12.5 (11.7–13.3)**	15.3 (13.9–16.6)**	15.2 (11.2–19.2)**
Total (750)	17.2 (15.4–18.9)	17.7 (16.7–18.6)	18.3 (17.0–19.6)	17.3 (13.4–21.2)
EFV, cm³
Male (378)	64.3 (55.2–73.4)	59.2 (54.6–63.8)	53.8 (46.7–60.9)	53.9 (34.0–73.9)
Female (372)	29.3 (24.8–33.8)	36.5 (33.9–39.1)**	41.6 (37.3–46.0)**	51.3 (36.0–66.6)**
Total (750)	49.5 (43.4–55.6)	47.7 (44.9–50.5)	47.2 (43.1–51.4)	52.4 (41.8–63.7)
PaCFV, cm³
Male (378)	83.8 (76.6–91.1)	80.5 (75.8–85.2)	79.2 (70.4–88.0)	74.6 (47.6–91.5)
Female (372)	68.5 (62.0–75.9)	76.6 (71.6–80.6)*	82.6 (75.4–89.9)**	94.6 (73.4–105.8)**
Total (750)	77.3 (72.0–82.6)	78.5 (75.0–81.5)	81.1 (75.5–86.6)	86.1 (70.2–92.1)

[i] Data are presented as mean (95% confidence interval, CI) for continuous and % (numbers, n) for categorical characteristics.

Abbreviations: CAD-CA, coronary artery atherosclerosis; CAD-msCA, CAD moderate to severe coronary atherosclerosis; CAC score, coronary artery calcium score; BMI, body mass index, kg/m²; WC, waist circumference, cm; VATA, visceral adipose tissue area, cm²; SATA, subcutaneous adipose tissue area, cm²; VATV, visceral adipose tissue volume, cm³; SATV, subcutaneous adipose tissue volume, cm³; LSR, liver-to-spleen attenuation ratio; PAFV, periaortic fat volume, cm³; EFV, epicardial fat volume, cm³; PaCFV, paracardial fat volume, cm³.

* p < 0.05 and ** p < 0.01 compared with the group of aged 50–59 years old.

Table 2

Plaque analysis in coronary arteries and branches.

	CAD-CA	CAD-mmCA	CAD-msCA
% (n)	57.2 (429)	34.5 (259)	22.7 (170)
CAC score	229.7 (174–284)	27.9 (18.3–37.5)	519.9 (398–641)**
CAC score maximum		786	4176
Plaque types
Plaques having non-calcified ones	57.1 (245)	55.3 (140)	59.7 (105)
Calcified plaques	24.2 (104)	28.5 (72)	18.2 (32)
Non-calcified plaques	26.6 (114)	38.7 (98)	9.1 (16)
Mixed plaques	6.1 (26)	8.3 (21)	2.8 (5)
Calcified and non-calcified plaques	11.4 (48)	7.9 (20)	15.9 (28)
Calcified and mixed plaques	12.6 (54)	7.9 (20)	19.3 (34)
Non-calcified and mixed plaques	5.2 (22)	4.7 (12)	5.7 (10)
All three types of plaques	14.5 (61)	4.0 (10)	29.0 (51)

[i] Data are presented as mean (95% confidence interval, CI) for continuous and % (numbers, n) for categorical characteristics.

Abbreviations: CAD-CA, coronary artery atherosclerosis; CAD-mmCA, CAD minimal to mild coronary atherosclerosis; CAD-msCA, CAD moderate to severe coronary atherosclerosis; CAC score, coronary artery calcium score.

** p < 0.01 compared with CAD-mmCA.

Table 3

The clinical characteristics and ectopic fat distribution of the participants.

	no CAD-CA (n = 321)	CAD-msCA/mmCA (n = 429)	p-value	No/CAD-mmCA (n = 574)	CAD-msCA (n = 176)	p-value
Gender, % men (n)	37.1 (119)	60.4 (259)	<0.001	43.4 (249)	73.3 (129)	<0.001
Age, years	62.7 (62.0–63.4)	66.3 (65.6–67.0)	<0.001	64.0 (63.4–64.6)	67.3 (66.2–68.4)	<0.001
CAD-CA, % (n)		57.2 (429)			23.5 (176)
CAC score	0	229.7 (174–284)	–	12.3 (7.9–16.6)	519.9 (398–641)	<0.001
Overweight, % (n)	36.4 (117)	48.3 (48.3)	0.004	41.5 (238)	48.9 (86)	0.029
Obesity, % (n)	13.4 (43)	13.1 (56)	0.132	12.0 (69)	17.0 (30)	0.038
Diabetes, % (n)	13.4 (43)	26.3 (113)	<0.001	17.1 (98)	33.0 (58)	<0.001
Hypertension, % (n)	52.3 16)	71.3 (306)	<0.001	59.8 (343)	74.4 (131)	<0.001
Current smoking, % (n)	19.6 (63)	27.0 (116)	0.011	22.6 (130)	27.8 (49)	0.066
Statin use, % (n)	6.9 (22)	16.8 (72)	<0.001	9.9 (57)	21.0 (37)	<0.001
HTN med, % (n)	32.4 (104)	52.0 (223)	<0.001	38.7 (222)	59.7 (105)	<0.001
DM med, % (n)	4.7 (15)	14.0 (60)	<0.001	7.1 (41)	19.3 (34)	<0.001
SBP, mmHg	128.3 (126–130)	136.7 (135–138)	<0.001	131.5 (130–132)	138.3 (135–140)	<0.001
BMI, kg/m²	24.3 (23.9–24.7)	24.8 (24.4–25.1)	0.043	24.4 (24.1–24.6)	25.3 (24.8–25.8)	0.001
WC, cm	89.0 (87.9–90.1)	91.4 (90.5–92.3)	0.007	89.6 (88.8–90.5)	92.7 (91.4–94.0)	<0.001
Ectopic fat deposition
VATA, cm²	120.0 (114–126)	134.4 (129–139)	<0.001	121.6 (117–125)	150.3 (141–158)	<0.001
SATA, cm²	191.7 (181–202)	183.2 (175–190)	0.180	187.3 (180–194)	185.2 (174–196)	<0.001
VATV, cm³	2171 (2042–2300)	2514 (2397–2630)	<0.001	2234 (2138–2329)	2807 (2618–2996)	0.776
SATV, cm³	2266 (2136–2397)	2327 (2165–2489)	0.585	2291 (2161–2422)	2335 (2152–2517)	<0.001
LSR	1.28 (1.25–1.31)	1.23 (1.21–1.25)	0.005	1.26 (1.24–1.28)	1.22 (1.19–1.26)	0.737
Fatty liver, % (n)	19.0 (61)	23.3 (100)	0.089	21.0 (119)	24.3 (42)	0.049
PAFV, cm³	15.0 (14.1–16.0)	19.7 (18.7–20.7)	<0.001	16.2 (15.5–17.0)	22.3 (20.6–24.0)	0.107
EFV, cm³	43.1 (39.8–46.5)	52.0 (49.0–54.9)	<0.001	44.7 (42.3–47.1)	59.5 (54.4–64.7)	<0.001
PaCFV, cm³	74.3 (70.6–78.0)	82.4 (79.1–85.6)	0.001	76.4 (73.7–79.1)	87.0 (81.6–92.5)	<0.001
Laboratory parameters
FG, mmol/L	5.46 (5.30–5.62)	6.14 (5.91–6.36)	<0.001	5.63 (5.49–5.77)	6.55 (6.12–6.97)	<0.001
HbA1c, %	5.83 (5.75–5.92)	6.13 (6.04–6.23)	<0.001	5.90 (5.83–5.96)	6.36 (6.17–6.54)	<0.001
Triglyceride, mmol/L	1.84 (1.70–1.97)	2.02 (1.89–2.15)	0.058	1.92 (1.81–2.03)	2.02 (1.84–2.19)	0.386
HDL-C, mmol/L	1.43 (1.38–1.47)	1.32 (1.28–1.36)	<0.001	1.41 (1.37–1.44)	1.23 (1.18–1.29)	<0.001
LDL-C, mmol/L	2.94 (2.82–3.06)	3.10 (2.95–3.26)	0.095	3.14 (3.07–3.21)	3.14 (2.99–3.30)	0.973

[i] Data are presented as mean (95 confidence interval, CI) for continuous and % (numbers, n) for categorical characteristics.

Abbreviations: CAD-CA, coronary artery atherosclerosis; CAD-msCA, CAD moderate to severe coronary atherosclerosis; CAD-mmCA, CAD minimal to mild coronary atherosclerosis; CAC score, coronary artery calcium score; BMI, body mass index, kg/m²; HTN med, hypertension medication; DM med, diabetes medication; SBP, systolic blood pressure, mmHg; WC, waist circumference, cm; VATA, visceral adipose tissue area, cm²; SATA, subcutaneous adipose tissue area, cm²; VATV, visceral adipose tissue volume, cm³; SATV, subcutaneous adipose tissue volume, cm³; LSR, liver-to-spleen attenuation ratio; PAFV, periaortic fat volume, cm³; EFV, epicardial fat volume, cm³; PaCFV, paracardial fat volume, cm³; FG, fast glucose, mmol/L; HbA1c, hemoglobin A1c, %; HDL-C, high-density lipoprotein cholesterol, mmol/L; LDL-C, low-density lipoprotein cholesterol, mmol/L.

Table 4

Pearson correlation of body ectopic fat from multiple fat depots.

Pearson value	r*	p value	r**	p-value	r***	p-value
BMI, kg/m²	0.426	<0.001	0.564	<0.001	–0.287	<0.001
WC, cm	0.402	<0.001	0.655	<0.001	–0.243	<0.001
PAFV, cm³	1		0.563	<0.001	–0.219	<0.001
VATA, cm²	0.563	<0.001	1		–0.289	<0.001
VATV, cm³	0.597	<0.001	0.704	<0.001	–0.323	<0.001
LSR	–0.219	<0.001	–0.289	<0.001	1
EFV, cm³	0.679	<0.001	0.580	<0.001	–0.186	<0.001

[i] Abbreviations: BMI, body mass index, kg/m²; meds, medications; WC, waist circumference, cm; PAFV, periaortic fat volume, cm³; VATA, visceral adipose tissue area, cm²; LSR, liver-to-spleen attenuation ratio; EFV, epicardial fat volume, cm³.

r* means the correlation coefficients between PAFV and other variables;

r** means the correlation coefficients between VATA and other variables;

r*** means the correlation coefficients between LSR and other variables.

Table 5

Multivariate association of body ectopic fat deposition and coronary artery atherosclerosis.

Variables	CAD-CA		CAD-msCA
Variables	OR (95% CI)	p-value	OR (95% CI)	p-value
Univariate model adjusted with age and gender
BMI, kg/m²	1.05 (1.01–1.11)	0.133	1.09 (1.03–1.15)	0.001
WC, cm	1.02 (1.01–1.04)	0.003	1.03 (1.01–1.05)	<0.001
VATA, cm²	1.00 (1.00–1.01)	0.011	1.01 (1.01–1.02)	<0.001
SATA, cm²	1.00 (0.99–1.00)	0.191	1.00 (0.99–1.00)	0.177
VATV, cm³	1.00 (1.00–1.00)	0.028	1.00 (1.00–1.00)	<0.001
SATV, cm³	1.00 (1.00–1.00)	0.073	1.00 (1.00–1.00)	0.137
LSR	0.29 (0.15–0.56)	0.002	0.52 (0.25–1.01)	0.050
PAFV, cm³	1.05 (1.03–1.07)	0.001	1.06 (1.04–1.08)	<0.001
EFV, cm³	1.01 (1.00–1.02)	0.021	1.01 (1.01–1.02)	<0.001
PaCFV, cm³	1.00 (1.00–1.01)	0.044	1.01 (1.00–1.02)	<0.001
Multivariate logistic regression model
WC, cm	1.02 (1.00–1.04)	0.039	1.02 (0.99–1.05)	0.146
VATA, cm²	1.00 (0.99–1.01)	0.904	1.00 (1.00–1.01)	0.003
SATA, cm²	1.00 (0.99–1.00)	0.609	1.00 (0.99–1.01)	0.101
VATV, cm³	1.00 (1.00–1.00)	0.307	1.00 (1.00–1.00)	0.017
SATV, cm³	1.00 (1.00–1.00)	0.105	1.00 (1.00–1.00)	0.229
LSR	0.44 (0.21–0.95)	0.036	0.83(0.35–1.94)	0.670
PAFV, cm³	1.02 (1.00–1.04)	0.028	1.02 (1.00–1.04)	0.024
EFV, cm³	1.00 (0.99–1.01)	0.286	1.01 (1.00–1.02)	0.022
PaCFV, cm³	1.00 (1.00–1.01)	0.074	1.00 (1.00–1.01)	0.014

[i] Abbreviations: OR, odds ratio; CI, confidence interval; CAD-CA, coronary artery atherosclerosis; CAD-msCA, moderate to severe coronary artery atherosclerosis; WC, waist circumference, cm; VATA, visceral adipose tissue area, cm²; SATA, subcutaneous adipose tissue area, cm²; VATV, visceral adipose tissue volume, cm³; SATV, subcutaneous adipose tissue volume, cm³; LSR, liver-to-spleen attenuation ratio; PAFV, periaortic fat volume, cm³; EFV, epicardial fat volume, cm³; PaCFV, paracardial fat volume, cm³.

Multivariate logistic regression model for body ectopic fat adjusted for age, gender, BMI, hypertension, diabetes, current smoking, TG, LDL-C and HDL-C.

Table 6

CT-derived PAFV/VATA and coronary atherosclerosis in Chinese middle aged and elderly patients.

PAFV and CAD-CA	CAD-CA Cases/Total	Prevalence of CAD-CA, OR (95% CI)
PAFV and CAD-CA	CAD-CA Cases/Total	Model 1	Model 2	Model 3
Logistic Regression	429/750	1.03 (1.01–1.05)**	1.02 (1.00–1.04)*	1.02 (1.00–1.04)
Per quartile*
Q1	71/188	Reference	Reference	Reference
Q2	105/187	1.76 (1.13–2.71)^	1.68 (1.03–2.65)^	1.33 (0.93–2.49)
Q3	119/187	1.93 (1.22–3.04)^^	1.74 (1.06–2.87)^	1.65 (1.00–2.73)
Q4	134/188	2.21 (1.33–3.68)^^	1.90 (1.07–3.37)^	1.73 (1.00–3.10)^
	CADmsCA Cases/Total	Prevalence of CAD-msCA, OR (95% CI)
	CADmsCA Cases/Total	Model 1	Model 2	Model 3
Logistic Regression	176/750	1.02 (1.01–1.04)	1.02 (1.00–1.04)	1.01 (0.99–1.03)
Per quartile*
Q1	16/188	Reference	Reference	Reference
Q2	37/187	2.19 (1.14–4.20)^	2.01 (1.03–3.93)^	1.98 (0.99–3.86)
Q3	53/187	2.77 (1.47–5.23)^^	2.18 (1.08–4.40)^	2.03 (1.00–4.12)
Q4	70/188	3.15 (1.64–6.05)^^	2.26 (1.17–4.42)^	2.20 (1.13–4.29)^
VATA and CAD	CAD-CA Cases/Total	Prevalence of CAD-CA, OR (95% CI)
VATA and CAD	CAD-CA Cases/Total	Model 1	Model 2	Model 3
Logistic Regression	429/750	1.00 (1.00–1.01)^	1.00 (0.99–1.01)	1.00 (0.99–1.01)
Per quartile*
Q1	84/188	Reference	Reference	Reference
Q2	97/187	1.33 (0.86–2.06)	1.13 (0.70–1.84)	1.07 (0.66–1.74)
Q3	129/187	2.27 (1.64–3.84)^^	1.96 (1.00–3.04)	1.73 (0.98–3.00)
Q4	119/188	1.90 (1.01–2.85)^	1.75 (0.98–2.50)	1.30 (0.84–2.04)
	CADmsCA Cases/Total	Incidence of CAD-msCA, OR (95% CI)
	CADmsCA Cases/Total	Model 1	Model 2	Model 3
Logistic Regression	176/750	1.01 (1.00–1.02)^^	1.01 (1.00–1.02)^	1.00 (1.00–1.01)^
Per quartile*
Q1	23/188	Reference	Reference	Reference
Q2	34/187	1.63 (0.88–2.98)	1.29 (0.67–2.47)	1.26 (0.65–2.43)
Q3	53/187	2.72 (1.54–4.81)^^	1.99 (1.04–3.79)^	1.94 (1.00–3.75)^
Q4	67/188	3.04 (1.74–5.32)^^	2.23 (1.14–4.39)^	2.07 (1.01–4.27)^

[i] Model 1: Adjusted for age and gender.

Model 2: As for model 1, additionally adjusted for BMI, current smoking, hypertension, diabetes, plasma low-density lipoprotein cholesterol and high-density lipoprotein cholesterol.

Model 3: As for model 2, additionally adjusted for waist circumference.

* The ranges of PAFV per quartile were as follows: Q1: 4.2–10.3cm³. Q2: 10.4–15.2 cm³. Q3: 15.3–22.7 cm³. Q4: 22.8–51.5 cm³, and VATA Q1: 21.8–89.2 cm³. Q2: 89.4–121.4 cm³. Q3: 121.7–156.6 cm³. Q4: 156.8–298.8 cm³.

Abbreviations: CT, computed tomography; CAD-CA, coronary artery atherosclerosis; CAD-msCA, moderate to severe coronary artery atherosclerosis; OR, odd ratio; CI, confidence interval.

^: p < 0.05, ^^: p < 0.01 in logistic regression analysis.

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DOI: https://doi.org/10.5334/gh.1078 | Journal eISSN: 2211-8179

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Language: English

Submitted on: Sep 29, 2021

Accepted on: Sep 29, 2021

Published on: Oct 19, 2021

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

body ectopic fat distribution,

periaortic fat,

visceral fat,

atherosclerosis,

coronary artery disease

© 2021 Jingqi Zhu, Zhangwei Yang, Xiaolin Li, Xiaoli Chen, Jingjiang Pi, Tao Zhuang, Jie Liu, Gang Li, Sheng Peng, Lin Zhang, Qi Zhang, Paul Chan, Brian Tomlinson, Huimin Fan, Liang Zheng, Zhongmin Liu, Yuzhen Zhang, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 16 (2021): Issue 1