Editorial
Understanding the Complex Relationship between Obesity Indices and Subclinical Atherosclerosis
2024 Volume 31 Issue 1 Pages 19-20
Details
2024 Volume 31 Issue 1 Pages 19-20
See article vol. 31: 48-60
Epidemiological studies have shown that obesity, especially increased visceral adipose tissue evaluated with computed tomography (CT), is an independent risk marker for cardiovascular and metabolic morbidity and mortality1). In contrast, coronary and aortic artery, and aortic valve calcifications are important markers of subclinical atherosclerosis, each offering unique insights into the risk of cardiovascular diseases2-4). These calcifications can serve as valuable prognostic tools for assessing the cardiovascular risk. Higher coronary artery calcification scores are associated with an elevated risk of atherosclerotic cardiovascular diseases3). Similar to coronary artery calcification, aortic artery calcification is also associated with traditional cardiovascular disease risks, such as hypertension and dyslipidemia, but its relationship with obesity and other adiposity indices may vary. Aortic valve calcification is a marker of valvular heart disease and is associated with an increased cardiovascular risk, particularly in older individuals4). Unlike coronary and aortic artery calcifications, limited research exists on the association between adiposity indices and aortic valve calcifications.
A study conducted by Higo et al.5) presented intriguing findings regarding the association between obesity indices and subclinical atherosclerosis. Subclinical atherosclerosis, characterized by the presence of calcifications in various arterial beds, is a significant risk factor for cardiovascular disease. In this comprehensive investigation, the researchers examined anthropometric measures and CT-based obesity indices in relation to coronary and aortic artery, and aortic valve calcifications in a population-based cohort of Japanese males. The key findings of this study revealed distinct patterns of association between obesity indices and atherosclerotic lesions. Coronary artery calcification was positively associated with anthropometric indices (such as body mass index and waist circumference) even after adjusting for traditional cardiovascular risk factors. However, this association disappeared after adjusting for body mass index, suggesting that anthropometric indices are more closely linked to coronary artery calcification than other obesity measures. In contrast, aortic artery calcification was significantly associated with CT-based obesity indices, specifically visceral adipose tissue-related measurements, such as the visceral adipose tissue to subcutaneous adipose tissue and the visceral adipose tissue to total adipose tissue ratios. Remarkably, these associations persisted even after adjusting for conventional cardiovascular risk factors and body mass index. These finding suggest that visceral adipose tissue-related indices may play a distinct role in assessing aortic artery calcification and its potential consequences. Surprisingly, no significant associations were found between the obesity indices and aortic valve calcification. This finding challenges the conventional wisdom regarding the relationship between obesity and valvular calcification. Statin use appeared to modify the association between obesity indices and aortic valve calcification, indicating potential interactions between medication and calcification processes.
The strengths of the study by Higo et al.5) include its rigorous methodology, large sample size, and thorough examination of multiple obesity indices, which shed light on the nuanced relationship between obesity and subclinical atherosclerosis in different arterial beds. However, this study has certain limitations, including its focus on middle-aged and older Japanese men, which may limit its generalizability to other populations.
In conclusion, this study highlighted the complex interplay between obesity and subclinical atherosclerosis. These findings suggest that different obesity indices are distinctly associated with various atherosclerotic lesions. These findings emphasize on the need for further research to better understand the mechanisms underlying these associations, and their clinical implications. Identifying specific obesity-related factors that contribute to different types of vascular calcification may ultimately help in developing targeted prevention and treatment strategies for cardiovascular diseases.
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