The role of central fat distribution in coronary artery disease in obesity: comparison of nondiabetic obese, diabetic obese, and normal weight subjects

OBJECTIVE: To investigate the degree of coronary artery disease (CAD) in re lation to obesity and fat distribution in obese patients with normal glucos e tolerance, in comparison with CAD of diabetic obese patients and of norma l weight subjects with CAD. DESIGN: Patients listed for coronary angiography with different body mass i ndex (BMI) with or without diabetes: study of the correlation between sever ity of coronary damage and fat distribution. SUBJECTS: 92 patients subdivided into: 30 normal glucose tolerant obese (BM I 31.7 +/- 0.5, aged 53 +/- 1.7 y), 28 type 2 diabetic: obese (BMI 30.7 +/- 0.3, aged 57 +/- 1.2 y), and 34 normal weight patients (BMI 23.1 +/- 0.3, aged 54 +/- 1.7 y). MEASUREMENTS: CAD assessed by angiography and evaluated according to the me thod of Gensini. Fat mass and fat distribution assessed by bioelectrical im pedance and anthropometry. Clinical, biochemical and hormonal variables, as well as smoking habits and alcohol intake. RESULTS: The angiographic coronary scores were similar in nondiabetic obese and in diabetic obese patients, and were significantly higher than those o f normal weight subjects. In the entire population coronary score correlate d with indices of abdominal fat distribution. In the stepwise analysis of e ach group separately, waist hip ratio (WHR) correlated with coronary score only in normal weight nondiabetic patients. CAD was inversely associated wi th BMI only in nondiabetic obese patients. CONCLUSION: CAD of obese patients: 1) is similar to that of diabetic obese patients; 2) is more severe than that of normal weight individuals; and 3) is inversely correlated with BMI. CAD appears to be associated with WHR, no t with BMI, only in nondiabetic patients with normal body weight. On the co ntrary, CAD of diabetic obese patients is unrelated to BMI and parameters o f fat distribution, but is associated with smoking habits.