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

Abstract

OBJECTIVETo investigate the association of the rate of weight gain (Rate max_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). RESEARCH DESIGN AND METHODSWe 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 Rate max_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 (Wt 20y ) was obtained from participant records. Participants recalled their maximum weight (Wt max ) before T2D diagnosis and age at maximum weight (Age max_wt ). The Rate max_wt was calculated as (Wt max -Wt 20y ) / (Age max_wt -20 years). RESULTSThe 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 Wt 20y and Wt max were 60.1 6 10.5 and 73.0 6 11.5 kg, respectively. Mean Age max_wt was 41.3 6 10.7 years, and Rate max_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. CONCLUSIONSThe findings suggest that a greater rate of prior weight gain may accelerate the development of subclinical vascular complications in patients with newly diagnosed T2D.

High burden of coronary atherosclerosis in patients with a new diagnosis of type 2 diabetes

“…As the structure of plaques are complex, the accurate mechanism of coronary plaque progression have not yet been proved but may be dependent on plaque composition, cardiovascular risk profile and level of inflammatory activation. 10,[36][37][38] Lehman et al 38 found that the differences in the rate of progression are dependent on plaque composition and that this progression may be greater for NCP compared with CP.…”

“…8,9 The literature regarding coronary artery disease and coronary plaque morphology in patients with newly diagnosed T2D is sparse. 10,11 Contrast-enhanced coronary computed tomography angiography (CCTA) has evolved as a robust imaging modality for ruling out significant coronary artery disease. 12,13 Moreover, CCTA permits detailed non-invasive coronary plaque assessment.…”

“…8,9 The literature regarding coronary artery disease and coronary plaque morphology in patients with newly diagnosed T2D is sparse. 10,11…”

Combined arteriosclerotic assessment of ankle-brachial index and maximum intima-media thickness via CCTA is useful for predicting coronary artery stenosis in patients with type 2 diabetes

“…The reason for this finding may be that diabetic patients are prone to arteriosclerosis, even in the early stages of the disease, and are likely to have advanced coronary disease when they start taking medication to help manage their diabetes. It is known that patients with type 2 DM and obesity are prone to coronary artery stenosis, even in the early stage of type 2 DM [27]. It is also known that patients with a longer duration of type 2 DM have more advanced coronary artery stenosis than those with a shorter disease duration [28].…”

Eating a Balanced Diet: A Healthy Life through a Balanced Diet in the Age of Longevity

“…5). Thus, attention should also be paid to obesity early in life and to the rate and speed of weight gain 13. Rapid weight gain causes insulin resistance, increases inflammatory responses, and raises blood sugar and blood pressure, fundamentally damaging intravascular endothelial cells, which could cause coronary artery disease.…”