Study On The Relationship Between Visceral Fat And Coronary Artery Calcification In Patients With Type 2 Diabetes Mellitus

ObjectiveMacroangiopathy is one of the most common chronic complications of type 2diabetes mellitus(T2DM),and its main pathological mechanism is atherosclerosis.Coronary artery calcification(CAC)is an important marker of coronary atherosclerosis and it is important for the prediction and diagnosis of coronary heart disease.Recent studies have shown that visceral obesity is closely related to insulin resistance,hypertension,dyslipidemia,renal function decline and other atherosclerotic factors.However,it is not clear whether visceral fat is related to CAC in patients with T2 DM.This study aims to investigate the relationship between visceral fat area(VA)and CAC in patients with T2 DM in order to provide new ideas for the prevention and treatment of cardiovascular complications.MethodsFrom January 2017 to July 2019,a total of 151 patients with T2 DM who treated in Department of Endocrinology of Affiliated Hospital of Jiangsu University were enrolled in this study.VA and coronary artery calcification score(CACS)were measured with Revolution CT.Based on CACS,patients were divided into non-calcification group(CACS<10,n=93)and calcification group(CACS?10,n=58).Anthropometric characteristics were measured by unified standard.Fasting plasma glucose(FPG),fasting insulin(FIns),fasting C-peptide(FC-P),liver function indexes,kidney function indexes and blood lipids.Homeostasis model of insulin resistance(HOMA-IR)and estimated glomerular filtration rate(eGFR)were calculated.The clinical characteristics were compared between the groups.Influence factors of CAC in patients with T2 DM were evaluated by Logistic regression analysis.Using receiver operating characteristic curve(ROC curve)analysis,the cutoff value and clinical significance of predicting CAC by VA were calculated for comparison with waist circumference(WC).Results(1)Compared with non-calcification group,age,duration of T2 DM,systolic blood pressure(SBP),WC,hip circumference,FIns,HOMA-IR,total cholesterol(TC),triglyceride(TG),blood urea nitrogen(BUN),VA were significantly increased in calcification group(P<0.05),while eGFR were significantly decreased(P<0.01).(2)According to VA,all patients were divided into tertiles,which include T1gruop(low VA),T2 gruop(medium VA),T3 gruop(high VA).With increasing of VA,the value of body mass index(BMI),SBP,WC,hip circumference,FIns,FC-P,HOMA-IR,TG,serum creatinine(SCr)and serum urate(SUA)increased gradually while eGFR decreased gradually(P<0.05).The prevalence of CAC were 18.0%,41.2%,56.0% in the T1,T2,T3 group,respectively.Those showed a significant rising trend(P<0.01).(3)Correlation analysis showed that VA was positively correlated with age,BMI,SBP,WC,FIns,FC-P,HOMA-IR,aspartate aminotransferase,alanine aminotransferase,gamma glutamyl transpeptidase,TG,SCr,SUA and CACS(P<0.05),and negatively correlated with high density lipoprotein cholesterol(HDL-C)and eGFR(P<0.01);CACS was positively correlated with age,duration of T2 DM,SBP,WC,FIns,HOMA-IR,TG,BUN and SUA(P<0.05),and negatively correlated with eGFR(P<0.01).(4)After dividing the patients into different subgroups,patients with advanced age,high blood pressure,dyslipidemia and renal insufficiency will have a higher level of VA and their prevalence of CAC will be increased(P<0.05).(5)Binary logistic regression demonstrated that VA was an independent risk factor for CAC in patients with T2 DM.According to VA,all subjects were divided into three groups: T1 group,T2 group,T3 group.The ORs of prevalence of CAC in T2 and T3 were 3.73(1.207,11.498)and 4.34(1.336,14.103)respectively,compared with T1 group after adjustment for age,sex,duration of T2 DM,smoke,BMI,SBP,TG,HDL-C and eGFR.(6)The area under curve(AUC)of VA for predicting CAC was 0.753,and thecorresponding sensitivity and specificity were 93.1% and 50.5% respectively.The AUC of WC for predicting CAC was 0.621,and the corresponding sensitivity and specificity were 67.2% and 51.6% respectively.The AUC of VA was significantly different from the AUC of WC(Z=3.005,P=0.002).Conclusions(1)With the increase of VA,the prevalence of CAC increased gradually in patients with T2 DM.(2)VA could be a risk factor of CAC.VA might more advantageous in predicting CAC than WC and suggests its potential role in predicting cardiovascular complications in patients with T2 DM.