Impact of abdominal fat distribution, visceral fat, and subcutaneous fat on coronary plaque scores assessed by 320-row computed tomography coronary angiography

Background and aims: Obesity is a risk factor for coronary artery disease (CAD), but the association between fat distribution, i.e., visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and coronary artery plaque morphology remains unclear. This study explored the association between abdominal fat distribution and coronary artery plaques. Methods: We retrospectively evaluated 4327 consecutive patients without CAD history, undergoing coronary computed tomography (CT) angiography. Plaques were assessed using segment stenosis score (SSS) and segment involvement score (SIS). We evaluated abdominal VAT and SAT areas using CT images. Patients were categorized into four groups: low VAT (< median)/low SAT (< median); low VAT/high SAT (>= median); high VAT (>= median)/low SAT; and high VAT/high SAT. Results: Mean age was 65 years (men, 66.4%). VAT area correlated with SSS (beta-coefficient = 0.11, p < 0.001) and SIS (beta-coefficient= 0.006, p < 0.001), whereas SAT area was inversely correlated with SSS (beta-coefficient =- 0.007, p < 0.001) and SIS (beta-coefficient=-0.004, p < 0.001). The low VAT/high SAT group had the lowest risk of higher SSS (>= 5) and SIS (>= 5) (odds ratio [OR] using low VAT/low SAT group as the reference category, 0.76, 95% confidence interval [CI], 0.61-0.95, p < 0.05; OR, 0.68, 95% CI, 0.53-0.88, p < 0.01, respectively) in multivariate analysis adjusted for age, sex, and traditional CAD risk factors. In the obese population (body mass index >= 25, n = 1694), the low VAT/high SAT group had the lowest risk of higher coronary plaque scores. Conclusions: Higher SAT and lower VAT were inversely correlated with the extent and severity of coronary artery plaques. Fat distribution may be useful for evaluating risk and prognosis of CAD.