The Association of Rate of Weight Gain During Early Adulthood With the Prevalence of Subclinical Coronary Artery Disease in Recently Diagnosed Type 2 Diabetes: The MAXWEL-CAD Study

Diabetes Care, Sep 2014

OBJECTIVE To investigate the association of the rate of weight gain (Ratemax_wt) between the age of 20 years and the age of maximum lifetime weight gain with indicators of subclinical coronary artery disease (CAD) at the time of diagnosis of type 2 diabetes (T2D).

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The Association of Rate of Weight Gain During Early Adulthood With the Prevalence of Subclinical Coronary Artery Disease in Recently Diagnosed Type 2 Diabetes: The MAXWEL-CAD Study

The Association of Rate of Weight Gain During Early Adulthood With the Prevalence of Subclinical Coronary Artery Disease in Recently Diagnosed Type 2 Diabetes: The MAXWEL-CAD Study Soo Lim 2 Sung Hee Choi 2 Kyoung Min Kim 2 Sang Il Choi 1 Eun Ju Chun 1 Min Joo Kim 0 Kyong Soo Park 4 Hak Chul Jang 2 Naveed Sattar 3 E P I D E M I O L O G Y / H E A L T H S E R V I C E S R E S E A R C H 0 Department of Internal Medicine, Korea Cancer Center Hospital , Seoul , Korea 1 Department of Radiology, Seoul National Uni- versity College of Medicine, Seoul National Uni- versity Bundang Hospital , Seongnam , Korea 2 Department of Internal Medicine, Seoul Na- tional University College of Medicine, Seoul Na- tional University Bundang Hospital , Seongnam , Korea 3 Institute of Cardiovascular and Medical Sci- ences, BHF Glasgow Cardiovascular Research Centre, Glasgow, U.K 4 Department of Internal Medicine, Seoul Na- tional University College of Medicine , Seoul , Korea RESEARCH DESIGN AND METHODS We studied 1,724 consecutive Korean subjects aged ‡30 years with recently diagnosed (within 3 months) T2D and one or more cardiovascular risk factors to investigate the association of Ratemax_wt with subclinical CAD. We used 64-slice cardiac computed tomography angiography to evaluate the degree of coronary artery stenosis, multivessel involvement, plaque characteristics, and coronary artery calcium score (CACS). Body weight at age 20 years (Wt20y) was obtained from participant records. Participants recalled their maximum weight (Wtmax) before T2D diagnosis and age at maximum weight (Agemax_wt). The Ratemax_wt was calculated as (Wtmax - Wt20y) / (Agemax_wt - 20 years). OBJECTIVE To investigate the association of the rate of weight gain (Ratemax_wt) between the age of 20 years and the age of maximum lifetime weight gain with indicators of subclinical coronary artery disease (CAD) at the time of diagnosis of type 2 diabetes (T2D). RESULTS The prevalence of coronary artery stenosis (‡50%), multivessel involvement (two or more vessels), plaque characteristics, and CACS ‡100 were 11.4%, 6.6%, 19.7%, and 12.8%, respectively. Mean Wt20y and Wtmax were 60.1 6 10.5 and 73.0 6 11.5 kg, respectively. Mean Agemax_wt was 41.3 6 10.7 years, and Ratemax_wt was 0.59 6 0.56 kg/year. After adjusting for cardiovascular risk factors, including current BMI, the highest quarter of prior weight gain was significantly associated with coronary artery stenosis, multivessel involvement, and plaque characteristics, particularly mixed and noncalcified plaque. CONCLUSIONS The findings suggest that a greater rate of prior weight gain may accelerate the development of subclinical vascular complications in patients with newly diagnosed T2D. Overweight and obesity are major risk factors for the development of type 2 diabetes (T2D) ( 1 ). Excess body fat increases insulin resistance, a condition characterized by increased insulin production and impaired glucose tolerance ( 2 ). Even if it does not lead to obesity, weight gain by itself is associated with an increased risk of T2D and its complications ( 3,4 ). We recently showed a U-shaped association of BMI at T2D diagnosis but with higher cardiovascular disease and total mortality risks beyond a BMI of 30 kg/m2 in white men and women living in Scotland (5). Although weight gain antedates the development of T2D by several years, quantitative investigation of the relationship between the amount and rate of weight gain and subclinical coronary artery disease (CAD) associated with T2D is lacking. Weight gain may affect coronary vascular health by influencing various risk factors, such as insulin resistance, dyslipidemia, hypertension, the inflammatory process, and the prothrombotic state. Upper-airway tightness associated with weight gain can induce obstructive sleep apnea syndrome, leading to systemic insulin resistance ( 6 ). Many studies have shown that overweight or obesity predisposes a person to heart diseases, such as heart failure and CAD ( 4,7 ). The pathophysiology of these entities and their link to obesity have been discussed previously (8). Recent advances in computed tomography (CT) technology have allowed for a detailed evaluation of the coronary arteries, including the extent of stenosis and plaque composition ( 9,10 ). Noncalcified or mixed plaques are known to be more vulnerable to rupture than stabilized calcified plaques (11). The current study examined the association between the rate of weight gain (Ratemax_wt) between the age of 20 years and the age at maximum lifetime weight with indicators of subclinical CAD at the time of T2D diagnosis. We hypothesized that rapid weight gain over and above the current BMI increases the risk of subclinical CAD in patients with newly diagnosed T2D. Study Population We established a cohort in 2006 to investigate the effect of maximum body weight in lifetime on the development of T2D and its complications, the MAXWEL ( 12 ). We screened 5,3 (...truncated)


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Soo Lim, Sung Hee Choi, Kyoung Min Kim, Sang Il Choi, Eun Ju Chun, Min Joo Kim, Kyong Soo Park, Hak Chul Jang, Naveed Sattar. The Association of Rate of Weight Gain During Early Adulthood With the Prevalence of Subclinical Coronary Artery Disease in Recently Diagnosed Type 2 Diabetes: The MAXWEL-CAD Study, Diabetes Care, 2014, pp. 2491-2499, 37/9, DOI: 10.2337/dc13-2365