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Взаимосвязь висцерального ожирения и коронарного кальциноза при ишемической болезни сердца
Взаимосвязь висцерального ожирения и коронарного кальциноза при ишемической болезни сердца
Брель Н.К., Груздева О.В., Коков А.Н., Масенко В.Л., Дылева Ю.А., Белик Е.В., Барбараш О.Л. Взаимосвязь висцерального ожирения и коронарного кальциноза при ишемической болезни сердца. Терапевтический архив. 2021;93(12):1428–1434.
DOI: 10.26442/00403660.2021.12.201277
DOI: 10.26442/00403660.2021.12.201277
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Аннотация
Цель. Оценка взаимосвязи распространенности висцерального ожирения и выраженности коронарного кальциноза (КК) у пациентов с верифицированной ишемической болезнью сердца (ИБС).
Материалы и методы. Обследованы 125 пациентов с ИБС. Оценка морфометрических характеристик висцеральной жировой ткани (ВЖТ) и КК выполнена при помощи мультиспиральной компьютерной томографии. Кальциевый индекс коронарных артерий определялся по методу Агатстона. Статистический анализ проведен с использованием программы Statistica 10.0.
Результаты. Висцеральное ожирение выявлено у 82 (65,6%) пациентов с ИБС. При наличии висцерального ожирения наблюдались более высокие значения КК в проекции огибающей (р=0,00014), правой коронарной (р=0,00002) артерии, общего кальциевого индекса (р=0,0003) и распространенности массивного КК. Корреляционный анализ показал взаимосвязь площади ВЖТ и КК всех исследуемых локализаций. По данным ROC-анализа висцеральное ожирение является значимым предиктором массивного КК (площадь под ROC-кривой 0,72, 95% доверительный интервал 0,56–0,89) в отличие от индекса массы тела (площадь под ROC-кривой 0,56, 95% доверительный интервал 0,31–0,82).
Заключение. Прямую корреляционную связь с КК имел индекс отношения ВЖТ к подкожной жировой ткани, но не индекс массы тела. Морфометрия ВЖТ может служить у пациентов с ИБС значимым диагностическим признаком массивного КК как фактора, влияющего на тактику лечения и прогноз.
Ключевые слова: ишемическая болезнь сердца, висцеральное ожирение, коронарный кальциноз, мультиспиральная компьютерная томография
Materials and methods. 125 patients with CAD were examined. Assessment of the morphometric characteristics of visceral adipose tissue (VAT) and CC was perform using multislice computed tomography (MSCT). The calcium index (CI) of the coronary arteries (CA) was determine by the Agatston method. Statistical analysis was perform using Statistica 10.0.
Results. VO was detect in 82 (65.6%) patients with CAD. In the presence of VO, higher CC values were observed in the projection of the envelope (p=0.00014), right coronary (p=0.00002) arteries, total CI (p=0.0003), and the prevalence of massive CC. Correlation analysis showed the relationship between the area of VAT and the CC of all the studied localizations. According to the ROC analysis, VO is a significant predictor of massive CC (area under the ROC curve – AUC 0.72, 95% CI 0.56–0.89), in contrast to body mass index – BMI (AUC 0.56, 95% CI 0.31–0.82).
Conclusion. The index of the ratio of VAT to subcutaneous adipose tissue (VAT/SAT), but not BMI, had a direct correlation with CC. Morphology of VAT may be a significant diagnostic sign of massive CC in patients with CAD, as a factor affecting treatment and prognosis.
Keywords: coronary artery disease, visceral obesity, coronary calcification, multislice computed tomography
Материалы и методы. Обследованы 125 пациентов с ИБС. Оценка морфометрических характеристик висцеральной жировой ткани (ВЖТ) и КК выполнена при помощи мультиспиральной компьютерной томографии. Кальциевый индекс коронарных артерий определялся по методу Агатстона. Статистический анализ проведен с использованием программы Statistica 10.0.
Результаты. Висцеральное ожирение выявлено у 82 (65,6%) пациентов с ИБС. При наличии висцерального ожирения наблюдались более высокие значения КК в проекции огибающей (р=0,00014), правой коронарной (р=0,00002) артерии, общего кальциевого индекса (р=0,0003) и распространенности массивного КК. Корреляционный анализ показал взаимосвязь площади ВЖТ и КК всех исследуемых локализаций. По данным ROC-анализа висцеральное ожирение является значимым предиктором массивного КК (площадь под ROC-кривой 0,72, 95% доверительный интервал 0,56–0,89) в отличие от индекса массы тела (площадь под ROC-кривой 0,56, 95% доверительный интервал 0,31–0,82).
Заключение. Прямую корреляционную связь с КК имел индекс отношения ВЖТ к подкожной жировой ткани, но не индекс массы тела. Морфометрия ВЖТ может служить у пациентов с ИБС значимым диагностическим признаком массивного КК как фактора, влияющего на тактику лечения и прогноз.
Ключевые слова: ишемическая болезнь сердца, висцеральное ожирение, коронарный кальциноз, мультиспиральная компьютерная томография
________________________________________________
Materials and methods. 125 patients with CAD were examined. Assessment of the morphometric characteristics of visceral adipose tissue (VAT) and CC was perform using multislice computed tomography (MSCT). The calcium index (CI) of the coronary arteries (CA) was determine by the Agatston method. Statistical analysis was perform using Statistica 10.0.
Results. VO was detect in 82 (65.6%) patients with CAD. In the presence of VO, higher CC values were observed in the projection of the envelope (p=0.00014), right coronary (p=0.00002) arteries, total CI (p=0.0003), and the prevalence of massive CC. Correlation analysis showed the relationship between the area of VAT and the CC of all the studied localizations. According to the ROC analysis, VO is a significant predictor of massive CC (area under the ROC curve – AUC 0.72, 95% CI 0.56–0.89), in contrast to body mass index – BMI (AUC 0.56, 95% CI 0.31–0.82).
Conclusion. The index of the ratio of VAT to subcutaneous adipose tissue (VAT/SAT), but not BMI, had a direct correlation with CC. Morphology of VAT may be a significant diagnostic sign of massive CC in patients with CAD, as a factor affecting treatment and prognosis.
Keywords: coronary artery disease, visceral obesity, coronary calcification, multislice computed tomography
Полный текст
Список литературы
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18. Park HJ, Kim J, Park SE, et al. Increased risk of subclinical atherosclerosis associated with high visceral adiposity index in apparently healthy Korean adults: the Kangbuk Samsung Health Study. Ann Med. 2016;48(6):410-6. DOI:10.1080/07853890.2016.1183258
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20. Cardoso L, Weinbaum S. Microcalcifications, Their Genesis, Growth, and Biomechanical Stability in Fibrous Cap Rupture. Adv Exp Med Biol. 2018;1097:129-55. DOI:10.1007/978-3-319-96445-4_7
21. Nadra I, Mason JC, Philippidis P, et al. Proinflammatory activation of macrophages by basic calcium phosphate crystals via protein kinase C and MAP kinase pathways: a vicious cycle of inflammation and arterial calcification? Circ Res. 2005;96(12):1248-56.
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22. Lee MJ, Park JT, Park KS, at al. Normal body mass index with central obesity has increased risk of coronary artery calcification in Korean patients with chronic kidney disease. Kidney Int. 2016;90(6):1368-76. DOI:10.1016/j.kint.2016.09.011
23. Folsom AR, Kronmal RA, Detrano RC, et al. Coronary artery calcification compared with carotid intima-media thickness in prediction of cardiovascular disease incidence: The Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med. 2008;168(12):1333-9. DOI:10.1001/archinte.168.12.1333
2. Dugani S, Gaziano TA. 25 by 25: achieving global reduction in cardiovascular mortality. Curr Cardiol Rep. 2016;18(1):10. DOI:10.1007/s11886-015-0679-4
3. Muromtseva GA, Kontsevaya AV, Konstantinov VV, et al. The prevalence of non-infectious diseases risk factors in Russian population in 2012–2013 years. The results of ECVD-RF. Cardiovascular Therapy and Prevention. 2014;13(6):4-11 (in Russian). DOI:10.15829/1728-8800-2014-6-4-11
4. Britton KA, Massaro JM, Murabito JM, et al. Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol. 2013;62(10):921-5. DOI:10.1016/j.jacc.2013.06.027
5. Rozanski A, Gransar H, Shaw LJ, et al. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing: the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) prospective randomized trial. J Am Coll Cardiol. 2011;57(15):1622-32.
DOI:10.1016/j.jacc.2011.01.019
6. McClelland RL, Jorgensen NW, Budoff M, et al. 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MeSA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study). J Am Coll Cardiol. 2015;66(15):1643-53. DOI:10.1016/j.jacc.2015.08.035
7. Matsuzawa Y, Nakamura T, Shimomura I, Kotani K. Visceral fat accumulation and cardiovascular disease. Obes Res.
1995;3(Suppl. 5):645-7. DOI:10.1002/j.1550-8528.1995.tb00481.x
8. Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827-32. DOI:10.1016/0735-1097(90)90282-T
9. Kokov AN, Brel NK, Masenko VL, et al. Quantitative assessment of visceral adipose depot in patients with ischemic heart disease by using of modern tomographic Methods. Complex Issues of Cardiovascular Diseases. 2017;3:113-9 (in Russian). DOI:10.17802/2306-1278-2017-6-3-113-119
10. Hung SP, Chen CY, Guo FR, et al. Combine body mass index and body fat percentage Measures to improve the accuracy of obesity screening in young adults. Obes Res Clin Pract. 2017;11(1):118.
DOI:10.1016/j.orcp.2016.02.005
11. Gruzdeva OV, Akbasheva OE, Borodkina DA, et al. Relationship of obesity parameters and adipokines with the risk of 2nd type diabetes development in a year after myocardial infarction. Russian Journal of Cardiology. 2015;4:59-67
(in Russian). DOI:10.15829/1560-4071-2015-4-59-67
12. Tang L, Zhang F, Tong N. The association of visceral adipose tissue and subcutaneous adipose tissue with Metabolic risk factors in a large population of Chinese adults. Clin Endocrinol (Oxf). 2016;85(1):46-53. DOI:10.1111/cen.13013
13. Bourantas CV, Zhang YJ, Garg S, et al. Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart. 2014;100(15):1158-64. DOI:10.1136/heartjnl-2013-305180
14. Zhang Y, Song L, Song Y, et al. Impact of coronary artery lesion calcification on the long-term outcome of patients with coronary heart disease after percutaneous coronary intervention. Zhonghua Xin Xue Guan Bing Za Zhi. 2019;47(1):34‐41.
DOI:10.3760/cma.j.issn.0253-3758.2019.01.004
15. Ertelt K, Généreux P, Mintz GS, et al. Impact of the severity of coronary artery calcification on clinical events in patients undergoing coronary artery bypass grafting (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial). Am J Cardiol. 2013;112(11):1730‐7. DOI:10.1016/j.amjcard.2013.07.038
16. Zykov MV, Hryachkova ON, Kashtalap VV, et al. Dynamics of Coronary Calcification and Its Association with the Clinical Course of Ischemic Heart Disease and Osteopenic Syndrome. Kardiologiia. 2019;59(4):12-20 (in Russian).
DOI:10.18087/cardio.2019.4.10247
17. Gruzdeva O, Uchasova E, Dyleva Y, et al. Adipocytes Directly Affect Coronary Artery Disease Pathogenesis via Induction of Adipokine and Cytokine Imbalances. Front Immunol. 2019;10:2163.
DOI:10.3389/fimmu.2019.02163
18. Park HJ, Kim J, Park SE, et al. Increased risk of subclinical atherosclerosis associated with high visceral adiposity index in apparently healthy Korean adults: the Kangbuk Samsung Health Study. Ann Med. 2016;48(6):410-6. DOI:10.1080/07853890.2016.1183258
19. Larsen BA, Laughlin GA, Cummins K, et al. Adipokines and severity and progression of coronary artery calcium: Findings from the Rancho Bernardo Study. Atherosclerosis. 2017;265:1-6.
DOI:10.1016/j.atherosclerosis.2017.07.022
20. Cardoso L, Weinbaum S. Microcalcifications, Their Genesis, Growth, and Biomechanical Stability in Fibrous Cap Rupture. Adv Exp Med Biol. 2018;1097:129-55. DOI:10.1007/978-3-319-96445-4_7
21. Nadra I, Mason JC, Philippidis P, et al. Proinflammatory activation of macrophages by basic calcium phosphate crystals via protein kinase C and MAP kinase pathways: a vicious cycle of inflammation and arterial calcification? Circ Res. 2005;96(12):1248-56.
DOI:10.1161/01.RES.0000171451.88616.c2
22. Lee MJ, Park JT, Park KS, at al. Normal body mass index with central obesity has increased risk of coronary artery calcification in Korean patients with chronic kidney disease. Kidney Int. 2016;90(6):1368-76. DOI:10.1016/j.kint.2016.09.011
23. Folsom AR, Kronmal RA, Detrano RC, et al. Coronary artery calcification compared with carotid intima-media thickness in prediction of cardiovascular disease incidence: The Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med. 2008;168(12):1333-9. DOI:10.1001/archinte.168.12.1333
2. Dugani S, Gaziano TA. 25 by 25: achieving global reduction in cardiovascular mortality. Curr Cardiol Rep. 2016;18(1):10. DOI:10.1007/s11886-015-0679-4
3. Муромцева Г.А., Концевая А.В., Константинов В.В., и др. Распространенность факторов риска неинфекционных заболеваний в российской популяции в 2012–2013 гг. Результаты исследования ЭССЕ-РФ. Кардиоваскулярная терапия и профилактика. 2014;13(6):4-11 [Muromtseva GA, Kontsevaya AV, Konstantinov VV, et al. The prevalence of non-infectious diseases risk factors in Russian population in 2012–2013 years. The results of ECVD-RF.
Cardiovascular Therapy and Prevention. 2014;13(6):4-11 (in Russian)]. DOI:10.15829/1728-8800-2014-6-4-11
4. Britton KA, Massaro JM, Murabito JM, et al. Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol. 2013;62(10):921-5. DOI:10.1016/j.jacc.2013.06.027
5. Rozanski A, Gransar H, Shaw LJ, et al. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing: the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) prospective randomized trial. J Am Coll Cardiol. 2011;57(15):1622-32.
DOI:10.1016/j.jacc.2011.01.019
6. McClelland RL, Jorgensen NW, Budoff M, et al. 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MeSA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study). J Am Coll Cardiol. 2015;66(15):1643-53. DOI:10.1016/j.jacc.2015.08.035
7. Matsuzawa Y, Nakamura T, Shimomura I, Kotani K. Visceral fat accumulation and cardiovascular disease. Obes Res.
1995;3(Suppl. 5):645-7. DOI:10.1002/j.1550-8528.1995.tb00481.x
8. Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827-32. DOI:10.1016/0735-1097(90)90282-T
9. Коков А.Н., Брель Н.К., Масенко В.Л., и др. Количественная оценка висцерального жирового депо у больных ишемической болезнью сердца с использованием современных томографических методик. Комплексные проблемы сердечно-сосудистых заболеваний. 2017;3:113-9 [Kokov AN, Brel NK, Masenko VL, et al. Quantitative assessment of visceral adipose depot in patients with ischemic heart disease by using of modern tomographic Methods. Complex Issues of Cardiovascular Diseases. 2017;3:113-9 (in Russian)]. DOI:10.17802/2306-1278-2017-6-3-113-119
10. Hung SP, Chen CY, Guo FR, et al. Combine body mass index and body fat percentage Measures to improve the accuracy of obesity screening in young adults. Obes Res Clin Pract. 2017;11(1):118.
DOI:10.1016/j.orcp.2016.02.005
11. Груздева О.В., Акбашева О.Е., Бородкина Д.А., и др. Взаимосвязь показателей ожирения и адипокинов с риском развития сахарного диабета 2 типа через год после перенесенного инфаркта миокарда. Российский кардиологический журнал. 2015;4:59-67 [Gruzdeva OV, Akbasheva OE, Borodkina DA, et al. Relationship of obesity parameters and adipokines with the risk of 2nd type diabetes development in a year after myocardial infarction. Russian Journal of Cardiology. 2015;4:59-67
(in Russian)]. DOI:10.15829/1560-4071-2015-4-59-67
12. Tang L, Zhang F, Tong N. The association of visceral adipose tissue and subcutaneous adipose tissue with Metabolic risk factors in a large population of Chinese adults. Clin Endocrinol (Oxf). 2016;85(1):46-53. DOI:10.1111/cen.13013
13. Bourantas CV, Zhang YJ, Garg S, et al. Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart. 2014;100(15):1158-64. DOI:10.1136/heartjnl-2013-305180
14. Zhang Y, Song L, Song Y, et al. Impact of coronary artery lesion calcification on the long-term outcome of patients with coronary heart disease after percutaneous coronary intervention. Zhonghua Xin Xue Guan Bing Za Zhi. 2019;47(1):34‐41.
DOI:10.3760/cma.j.issn.0253-3758.2019.01.004
15. Ertelt K, Généreux P, Mintz GS, et al. Impact of the severity of coronary artery calcification on clinical events in patients undergoing coronary artery bypass grafting (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial). Am J Cardiol. 2013;112(11):1730‐7. DOI:10.1016/j.amjcard.2013.07.038
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14. Zhang Y, Song L, Song Y, et al. Impact of coronary artery lesion calcification on the long-term outcome of patients with coronary heart disease after percutaneous coronary intervention. Zhonghua Xin Xue Guan Bing Za Zhi. 2019;47(1):34‐41.
DOI:10.3760/cma.j.issn.0253-3758.2019.01.004
15. Ertelt K, Généreux P, Mintz GS, et al. Impact of the severity of coronary artery calcification on clinical events in patients undergoing coronary artery bypass grafting (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial). Am J Cardiol. 2013;112(11):1730‐7. DOI:10.1016/j.amjcard.2013.07.038
16. Zykov MV, Hryachkova ON, Kashtalap VV, et al. Dynamics of Coronary Calcification and Its Association with the Clinical Course of Ischemic Heart Disease and Osteopenic Syndrome. Kardiologiia. 2019;59(4):12-20 (in Russian).
DOI:10.18087/cardio.2019.4.10247
17. Gruzdeva O, Uchasova E, Dyleva Y, et al. Adipocytes Directly Affect Coronary Artery Disease Pathogenesis via Induction of Adipokine and Cytokine Imbalances. Front Immunol. 2019;10:2163.
DOI:10.3389/fimmu.2019.02163
18. Park HJ, Kim J, Park SE, et al. Increased risk of subclinical atherosclerosis associated with high visceral adiposity index in apparently healthy Korean adults: the Kangbuk Samsung Health Study. Ann Med. 2016;48(6):410-6. DOI:10.1080/07853890.2016.1183258
19. Larsen BA, Laughlin GA, Cummins K, et al. Adipokines and severity and progression of coronary artery calcium: Findings from the Rancho Bernardo Study. Atherosclerosis. 2017;265:1-6.
DOI:10.1016/j.atherosclerosis.2017.07.022
20. Cardoso L, Weinbaum S. Microcalcifications, Their Genesis, Growth, and Biomechanical Stability in Fibrous Cap Rupture. Adv Exp Med Biol. 2018;1097:129-55. DOI:10.1007/978-3-319-96445-4_7
21. Nadra I, Mason JC, Philippidis P, et al. Proinflammatory activation of macrophages by basic calcium phosphate crystals via protein kinase C and MAP kinase pathways: a vicious cycle of inflammation and arterial calcification? Circ Res. 2005;96(12):1248-56.
DOI:10.1161/01.RES.0000171451.88616.c2
22. Lee MJ, Park JT, Park KS, at al. Normal body mass index with central obesity has increased risk of coronary artery calcification in Korean patients with chronic kidney disease. Kidney Int. 2016;90(6):1368-76. DOI:10.1016/j.kint.2016.09.011
23. Folsom AR, Kronmal RA, Detrano RC, et al. Coronary artery calcification compared with carotid intima-media thickness in prediction of cardiovascular disease incidence: The Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med. 2008;168(12):1333-9. DOI:10.1001/archinte.168.12.1333
Авторы
Н.К. Брель1, О.В. Груздева*1,2, А.Н. Коков1, В.Л. Масенко1, Ю.А. Дылева1, Е.В. Белик1, О.Л. Барбараш1,2
1 ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», Кемерово, Россия;
2 ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России, Кемерово, Россия
*o_gruzdeva@mail.ru
1 Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia;
2 Kemerovo State Medical University, Kemerovo, Russia
*o_gruzdeva@mail.ru
1 ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», Кемерово, Россия;
2 ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России, Кемерово, Россия
*o_gruzdeva@mail.ru
________________________________________________
1 Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia;
2 Kemerovo State Medical University, Kemerovo, Russia
*o_gruzdeva@mail.ru
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