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)