Usefulness of hypertriglyceridemic waist phenotype in type 2 diabetes mellitus to predict the presence of coronary artery disease as assessed by computed tomographic coronary angiography.

The present study tested whether in patients with type 2 diabetes mellitus (DM) the combination of increased waist circumference and increased plasma triglyceride (TG) levels can predict the presence of coronary artery disease (CAD) as assessed by multidetector computed tomographic coronary angiography (CTA). In 202 patients with type 2 DM who were clinically referred for CTA, waist circumference and TG levels were measured. Patients were divided into 4 groups according to waist circumference measurements and TG levels. Increased waist circumference and TG levels (n = 61, 31%) indicated the presence of the hypertriglyceridemic waist phenotype. Patients with low waist circumference and TG (n = 49, 24%) were considered the reference group. Physical examination and blood measurements were performed. CTA was used to determine presence and severity of CAD. In addition, plaque type was evaluated. Plasma cholesterol levels were significantly increased in the group with increased TG levels and waist circumference, whereas high-density lipoprotein cholesterol was significantly lower than in the reference group. There was a significant increase in the presence of any CAD (odds ratio 3.3, confidence interval 1.31 to 8.13, p <0.05) and obstructive CAD (≥50%, odds ratio 2.9, confidence interval 1.16 to 7.28, p <0.05) in the group with increased TG level and waist circumference. In addition, a significantly larger number of noncalcified and mixed plaques was observed. In conclusion, in patients with type 2 DM, presence of the hypertriglyceridemic waist phenotype translated into a deteriorated blood lipid profile and more extensive CAD on CTA. Accordingly, the hypertriglyceridemic waist phenotype may serve as a practical clinical biomarker to improve risk stratification in patients with type 2 DM.

[1]  Nico Mollet,et al.  Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. , 2004, Radiology.

[2]  P. Wilson,et al.  Change in LDL particle size is associated with change in plasma triglyceride concentration. , 1992, Arteriosclerosis and thrombosis : a journal of vascular biology.

[3]  Jeroen J. Bax,et al.  Evaluation of plaque characteristics in acute coronary syndromes: non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis. , 2008, European heart journal.

[4]  Peter Libby,et al.  Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. , 2002, JAMA.

[5]  J. Mckenney,et al.  Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). , 2001, JAMA.

[6]  D. Gaudet,et al.  Hypertriglyceridemic waist: A marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men? , 2000, Circulation.

[7]  Borut Marincek,et al.  Optimal image reconstruction intervals for non-invasive coronary angiography with 64-slice CT , 2006, European Radiology.

[8]  G. Beller.  Noninvasive screening for coronary atherosclerosis and silent ischemia in asymptomatic type 2 diabetic patients: is it appropriate and cost-effective? , 2007, Journal of the American College of Cardiology.

[9]  Jeroen J. Bax,et al.  Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. , 2006, Journal of the American College of Cardiology.

[10]  J. Després,et al.  The Dense LDL Phenotype: Association with plasma lipoprotein levels, visceral obesity, and hyperinsulinemia in men , 1996, Diabetes Care.

[11]  N. Unwin,et al.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel on Executive Summary of the Third Report of the National , 2009 .

[12]  Jeroen J. Bax,et al.  Evaluation of contraindications and efficacy of oral Beta blockade before computed tomographic coronary angiography. , 2010, The American journal of cardiology.

[13]  Teven,et al.  MORTALITY FROM CORONARY HEART DISEASE IN SUBJECTS WITH TYPE 2 DIABETES AND IN NONDIABETIC SUBJECTS WITH AND WITHOUT PRIOR MYOCARDIAL INFARCTION , 2000 .

[14]  Hirofumi Anno,et al.  Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. , 2007, Journal of the American College of Cardiology.

[15]  P. Raskin,et al.  Report of the expert committee on the diagnosis and classification of diabetes mellitus. , 1999, Diabetes care.

[16]  Jeroen J. Bax,et al.  Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease. , 2010, European heart journal.

[17]  E. Barrett,et al.  Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. , 2009, JAMA.

[18]  J. Després,et al.  Prevalence of 'hypertriglyceridemic waist' in men who participated in the Quebec Health Survey: association with atherogenic and diabetogenic metabolic risk factors. , 2002, Canadian Journal of Cardiology.

[19]  S. Kaul,et al.  Screen testing cardiovascular prevention in asymptomatic diabetic patients. , 2007, Journal of the American College of Cardiology.

[20]  D. Spevack,et al.  Relationship between noninvasive coronary angiography with multislice computerized tomography and myocardial perfusion imaging. , 2006, Journal of the American College of Cardiology.

[21]  J. Després,et al.  Relation of the "hypertriglyceridemic waist" phenotype to earlier manifestations of coronary artery disease in patients with glucose intolerance and type 2 diabetes mellitus. , 2007, The American journal of cardiology.

[22]  Consensus Development Conference on the Diagnosis of Coronary Heart Disease in People With Diabetes: 10–11 February 1998, Miami, Florida , 1998, Diabetes Care.

[23]  Jeroen J. Bax,et al.  Differences in plaque composition and distribution in stable coronary artery disease versus acute coronary syndromes; non‐invasive evaluation with multi‐slice computed tomography , 2007, Acute cardiac care.