Abdominal obesity tied to more than 4-fold risk of coronary artery calcification in CKD patients: Study

In the large population-based study, the researchers observed close associations between CKD and abdominal obesity with increased risks of both positive CAC and severe CAC.

"Participants with CKD exhibited adjusted odds ratios (ORs) of 1.1 and 2.6 for positive CAC and severe CAC, respectively, and the participants with AO had adjusted ORs of 1.4 and 1.8 for positive CAC and severe CAC, respectively," the researchers reported.

"The combined effects of CKD and AO resulted in increased ORs of 2.4 and 4.4 for positive CAC and severe CAC, respectively."

An elevated CAC score indicates the increased presence of fibro-calcified lesions in the coronary arteries, resulting in increased vessel wall stiffness. Accordingly, the CAC score is regarded as a robust predictive marker of coronary artery disease (CAD) risk.

Cardiovascular disease is the main cause of mortality in CKD patients, with the risk exacerbated by metabolic disorders. Compared with body mass index (BMI), waist circumference (WC) has been suggested as a more effective indicator of abnormal visceral fat. However, the associations between CKD, abnormal WC, and cardiovascular disease (CVD) have not been studied well.

Although both CKD and abdominal obesity independently raise CAD incidence, the combined effects of CKD and AO on CAC remain uncertain. CKD. Accordingly, Peng-Tzu Liu and Jong-Dar Chen from the Department of Family Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan, elucidated this association and highlighted the importance of waist circumference as a clinical parameter for assessing patients with pre-dialysis

For this purpose, they conducted a cross-sectional study in Taiwan from 2006 to 2016 comprising 10,342 participants undergoing self-paid health checkups at a single medical centre. Blood samples and physical examinations were taken to assess metabolic parameters, and the Chronic Kidney Disease Epidemiology Collaboration formula was used for evaluating renal function.

Coronary artery calcification scores were determined through coronary 256-slice multidetector computed tomography angiography, with a CAC score of >0 Agatston unit (AU) and ≥ 400 AU denoting positive CAC and severe CAC, respectively.

Sex-based comparisons were conducted between individuals with chronic kidney disease and those without CKD.

The study revealed the following findings:

• In the CKD group, both sexes exhibited significantly elevated levels of systolic blood pressure, haemoglobin A1c (HbA1c), and serum fasting blood glucose (FBG), as well as reduced serum high-density lipoprotein cholesterol.
• Examination of the associations of abnormal WC revealed that for both sexes, individuals with abdominal obesity were significantly older and had higher systolic/diastolic blood pressure, serum FBG, HbA1c, and lipid profiles compared with those without AO.
• Multiple logistic regression analysis revealed that CKD patients exhibited a more pronounced association with severe CAC scores, compared with AO patients (odds ratios [ORs]: 2.7 and 1.4, respectively).
• The combined effects of AO and CKD (AO[+]/CKD[+]) resulted in increased risks of positive CAC (OR: 2.4) and severe CAC (OR: 4.4).

To conclude, the study provides evidence for the combined effects of chronic kidney disease and abdominal obesity on CAC. The participants with both CKD and AO exhibited 2.4- and 4.4-fold increased risks of positive CAC and severe CAC, respectively.

"Accordingly, in clinical practice, increased attention should be paid to reduce AO for individuals with CKD," the researchers wrote.

Reference:

Liu PT, Chen JD. The Associations Between Abdominal Obesity and Coronary Artery Calcification in Chronic Kidney Disease Population. Int J Nephrol Renovasc Dis. 2024 Feb 1;17:39-45. doi: 10.2147/IJNRD.S446445. PMID: 38317662; PMCID: PMC10840527.