IMPORTANCE OF INTRAABDOMINAL VISCERAL FAT ACCUMULATION TO CORONARY ATHEROSCLEROSIS IN HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA

OBJECTIVES: Hyper-low-density lipoprotein (LDL)-cholesterolaemia is a potent risk factor for coronary atherosclerosis. We have recently demo nstrated that: a cluster of risk factors including insulin resistance, glucose intolerance, hypertriglyceridaemia, and hypertension based on infra-abdominal visceral fat accumulation are closely related to coro nary artery disease. In the current study, we evaluated the relationsh ip between visceral fat accumulation and the severity and distribution of coronary atherosclerosis in familial hypercholesterolaemia (FH). D ESIGN: The effect of visceral fat accumulation era coronary lesions an d risk factors in patients with FH was investigated. SUBJECTS: Thirty- one male patients with heterozygous FH who underwent coronary angiogra phy. MEASUREMENTS: Abdominal fat distribution was estimated by a cross -sectional computed tomographic scan at the umbilical fever, Plasma li pid, glucose and insulin concentrations and blood pressure were measur ed. A 75 q oral glucose tolerance test was also performed. RESULTS: Th e patients were divided into two groups according to the degree of vis ceral fat accumulation. Fifteen patients had high visceral fat accumul ation (High VF group) and 16 patients had normal visceral fat accumula tion (Normal VF group). Body mass index (BMI) and subcutaneous fat are a were significantly higher in the high VF group. Baseline serum trigl yceride was significantly higher and baseline low-density lipoprotein (LDL)-cholesterol and reduction of LDL-cholesterol during treatment we re significantly lower its High VF group. Fasting plasma glucose and i nsulin concentrations, and systolic and diastolic pressures were signi ficantly higher in the High VF group. Significant correlations were fo und between visceral fat area and the sum of the glucose and insulin c oncentration during an oral glucose tolerance test. Visceral fat area was significantly correlated with the severity of coronary stenosis in dex. Distal coronary lesions were significantly more frequent in the H igh VF group. moreover, the correlation between the visceral fat area and coronary stenosis index was found to be independent af age, BMI, a nd subcutaneous fat area by multiple regression analysis. CONCLUSIONS: Visceral fat accumulation is a potent cardiovascular risk factor in h eterozygous FH.