Diabetes & Metabolism Journal

Original Articles

Cardiovascular Risk/Epidemiology
Clinical Significance of Body Fat Distribution in Coronary Artery Calcification Progression in Korean Population: Heesun Lee, Hyo Eun Park, Ji Won Yoon, Su-Yeon Choi; Diabetes Metab J. 2021;45(2):219-230. Published online October 28, 2020; DOI: https://doi.org/10.4093/dmj.2019.0161; Correction in: Diabetes Metab J 2021;45(6):974

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Background
Although obesity differs according to ethnicity, it is globally established as a solid risk factor for cardiovascular disease. However, it is not fully understood how obesity parameters affect the progression of coronary artery calcification (CAC) in Korean population. We sought to evaluate the association of obesity-related parameters including visceral adipose tissue (VAT) measurement and CAC progression.
Methods
This retrospective observational cohort study investigated 1,015 asymptomatic Korean subjects who underwent serial CAC scoring by computed tomography (CT) with at least 1-year interval and adipose tissue measurement using non-contrast CT at baseline for a routine checkup between 2003 and 2015. CAC progression, the main outcome, was defined as a difference of ≥2.5 between the square roots of the baseline and follow-up CAC scores using Agatston units.
Results
During follow-up (median 39 months), 37.5% of subjects showed CAC progression of a total population (56.4 years, 80.6% male). Body mass index (BMI) ≥25 kg/m², increasing waist circumferences (WC), and higher VAT/subcutaneous adipose tissue (SAT) area ratio were independently associated with CAC progression. Particularly, predominance of VAT over SAT at ≥30% showed the strongest prediction for CAC progression (adjusted hazard ratio, 2.20; P<0.001) and remained of prognostic value regardless of BMI or WC status. Further, it provided improved risk stratification of CAC progression beyond known prognosticators.
Conclusion
Predominant VAT area on CT is the strongest predictor of CAC progression regardless of BMI or WC in apparently healthy Korean population. Assessment of body fat distribution may be helpful to identify subjects at higher risk.

Citations

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Gender-specific abdominal fat distribution and insulin resistance associated with organophosphate esters and phthalate metabolites exposure
Xiaoliu Shi, Wanyue Wang, Jiafan Feng, Xiaochun Ma, Mengting Xu, Cui Wang
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The association between C-reactive protein and coronary artery calcification: a systematic review and meta-analysis
Amirhossein Tajani, Masoumeh Sadeghi, Navid Omidkhoda, Amir Hooshang Mohammadpour, Sara Samadi, Vahid Jomehzadeh
BMC Cardiovascular Disorders.2024;[Epub] CrossRef
Visceral Obesity and Its Association with Severe Coronary Artery Calcification in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease
Min Kyu Kang, Jeung Eun Song, Young Oh Kweon, Won Young Tak, Soo Young Park, Yu Rim Lee, Jung Gil Park
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From Cells to Plaques: The Molecular Pathways of Coronary Artery Calcification and Disease
Andreas Mitsis, Elina Khattab, Evi Christodoulou, Kimon Myrianthopoulos, Michael Myrianthefs, Stergios Tzikas, Antonios Ziakas, Nikolaos Fragakis, George Kassimis
Journal of Clinical Medicine.2024; 13(21): 6352. CrossRef
Visceral adipose tissue is an independent predictor and mediator of the progression of coronary calcification: a prospective sub-analysis of the GEA study
Neftali Eduardo Antonio-Villa, Juan Gabriel Juárez-Rojas, Rosalinda Posadas-Sánchez, Juan Reyes-Barrera, Aida Medina-Urrutia
Cardiovascular Diabetology.2023;[Epub] CrossRef
Deep learning-based prediction for significant coronary artery stenosis on coronary computed tomography angiography in asymptomatic populations
Heesun Lee, Bong Gyun Kang, Jeonghee Jo, Hyo Eun Park, Sungroh Yoon, Su-Yeon Choi, Min Joo Kim
Frontiers in Cardiovascular Medicine.2023;[Epub] CrossRef
Relationship between a novel non–insulin-based metabolic score for insulin resistance (METS‐IR) and coronary artery calcification
Zhenwei Wang, Xiaofang Hui, Xu Huang, Jingjie Li, Naifeng Liu
BMC Endocrine Disorders.2022;[Epub] CrossRef
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Yuan Cheng, Zhongyu Wang, Xiaoxuan Jia, Rong Zhou, Jianliu Wang
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A. M. Tindall, V. A. Stallings
Annals of Human Biology.2021; 48(6): 517. CrossRef

Complications
Serum Total Bilirubin Levels Provide Additive Risk Information over the Framingham Risk Score for Identifying Asymptomatic Diabetic Patients at Higher Risk for Coronary Artery Stenosis: Jaechan Leem, Eun Hee Koh, Jung Eun Jang, Chang-Yun Woo, Jin Sun Oh, Min Jung Lee, Joon-Won Kang, Tae-Hwan Lim, Chang Hee Jung, Woo Je Lee, Joong-Yeol Park, Ki-Up Lee; Diabetes Metab J. 2015;39(5):414-423. Published online October 22, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.5.414

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Background

The diagnosis of coronary artery disease (CAD) is often delayed in patients with type 2 diabetes. Serum total bilirubin levels are inversely associated with CAD. However, no studies have examined whether this can be used as a biochemical marker for identifying asymptomatic diabetic patients at higher risk for having obstructive CAD.

Methods

We performed a cross-sectional study of 460 consecutive asymptomatic patients with type 2 diabetes. All patients underwent coronary computed tomographic angiography, and their serum total bilirubin levels were measured. Obstructive CAD was defined as ≥50% diameter stenosis in at least one coronary artery.

Results

Serum total bilirubin tertiles showed an inverse association with the prevalence of obstructive CAD. In multivariate logistic regression analysis, the odds ratio for the highest versus the lowest tertile of total bilirubin was 0.227 (95% confidence interval [CI], 0.130 to 0.398), and an increment of 1 µmol/L in serum total bilirubin level was associated with a 14.6% decrease in obstructive CAD after adjustment for confounding variables. Receiver operating characteristic curve analysis showed that the area under the curve for the Framingham Risk Score (FRS) plus serum total bilirubin level was 0.712 (95% CI, 0.668 to 0.753), which is significantly greater than that of the FRS alone (P=0.0028).

Conclusion

Serum total bilirubin level is inversely associated with obstructive CAD and provides additive risk information over the FRS. Serum total bilirubin may be helpful for identifying asymptomatic patients with type 2 diabetes who are at higher risk for obstructive CAD.

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DECREASE IN SERUM BILIRUBIN AS AN UNFAVORABLE MARKER OF CARDIOVASCULAR DISORDERS
L. M. Strilchuk, O. O. Zimba, I. B. Zhakun
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Contemporary diagnostic algorithm for coronary artery disease: achievements and prospects
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Supplementation with Phycocyanobilin, Citrulline, Taurine, and Supranutritional Doses of Folic Acid and Biotin—Potential for Preventing or Slowing the Progression of Diabetic Complications
Mark McCarty
Healthcare.2017; 5(1): 15. CrossRef
Effect of bilirubin concentration on the risk of diabetic complications: A meta-analysis of epidemiologic studies
Bo Zhu, Xiaomei Wu, Yifei Bi, Yang Yang
Scientific Reports.2017;[Epub] CrossRef
Role of Bilirubin in Diabetic Vascular Complications: Can Bilirubin Predict More than Just Liver Disease?
Jun Sung Moon
Diabetes & Metabolism Journal.2015; 39(5): 384. CrossRef

Diagnostic Accuracy of 64-Slice MDCT Coronary Angiography for the Assessment of Coronary Artery Disease in Korean Patients with Type 2 Diabetes: Jun Sung Moon, Ji Sung Yoon, Kyu Chang Won, Ihn-Ho Cho, Hyoung Woo Lee; Diabetes Metab J. 2013;37(1):54-62. Published online February 15, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.1.54

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Abstract PDF PubReader

Background

A 64-slice multidetector computed tomography (MDCT) is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8±9.5 years). We compared significant coronary stenosis (>50% luminal narrowing) in MDCT with invasive coronary angiography (ICA) by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy.

Results

Of the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109) were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226) were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222), 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74), 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (≥25 kg/m²) and coronary calcium score did not also affect the diagnostic accuracy of MDCT.

Conclusion

The 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.

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PLOS ONE.2015; 10(9): e0137478. CrossRef
Serum Total Bilirubin Levels Provide Additive Risk Information over the Framingham Risk Score for Identifying Asymptomatic Diabetic Patients at Higher Risk for Coronary Artery Stenosis
Jaechan Leem, Eun Hee Koh, Jung Eun Jang, Chang-Yun Woo, Jin Sun Oh, Min Jung Lee, Joon-Won Kang, Tae-Hwan Lim, Chang Hee Jung, Woo Je Lee, Joong-Yeol Park, Ki-Up Lee
Diabetes & Metabolism Journal.2015; 39(5): 414. CrossRef
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Atherosclerosis.2015; 243(1): 300. CrossRef
Role of Bilirubin in Diabetic Vascular Complications: Can Bilirubin Predict More than Just Liver Disease?
Jun Sung Moon
Diabetes & Metabolism Journal.2015; 39(5): 384. CrossRef
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
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Retraction: Diagnostic Accuracy of 64-Slice MDCT Coronary Angiography for the Assessment of Coronary Artery Disease in Korean Patients with Type 2 Diabetes
Jun Sung Moon, Ji Sung Yoon, Kyu Chang Won, Ihn-Ho Cho, Hyoung Woo Lee
Diabetes & Metabolism Journal.2013; 37(3): 217. CrossRef

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