Differential association between obesity and coronary artery disease according to the presence of diabetes in a Korean population

Background: Coronary artery disease (CAD) is a major cardiovascular complication in diabetic patients. Despite th significant association between obesity and diabetes, the majority of the diabetic subjects are not obese in an Asia population. This study evaluated the association between obesity and coronary artery disease (CAD) according t the diabetes status in a Korean population Methods: The association between obesity and CAD using the parameters of any plaque, obstructive plaque, an coronary artery calcium score (CACS) >100 according to the presence of diabetes was evaluated in 7,234 Korea adults who underwent multi-detector computed tomography for general health evaluations. Obesity was define as a body mass index (BMI) ≥25 kg/m2 Results: The prevalence of obesity was significantly higher in diabetic subjects than in non-diabetic subjects, but th majority of the diabetic subjects were non-obese (48% vs. 37%, p <0.001). The incidence of any plaque (58% vs. 29%) obstructive plaque (20% vs. 6%), and CACS >100 (20% vs. 6%) were significantly higher in diabetic patients tha in non-diabetic subjects (p <0.001, respectively). Incidence of any plaque (33% vs. 26%, p <0.001), obstructiv plaque (7% vs. 6%, p = 0.014), and CACS >100 (8% vs. 6%, p = 0.002) was significantly higher in non-diabetic subject with obesity than in those without obesity, but the incidence of all coronary parameters was not different in diabeti subjects according to the obesity status. After adjusting for confounding risk factors including age, gender hypertension, dyslipidemia, current smoking, and mild renal dysfunction, obesity was independently associate with increased risks of any plaque (OR 1.14) and CACS >100 (OR 1.31) only in non-diabetic subjects (p <0.05 respectively). Multiple logistic regression models revealed that diabetes was independently associated with all coronar parameters Conclusion: Despite a significantly higher prevalence of obesity in diabetic subjects than in non-diabetic subjects obesity is associated with the presence of any plaque and severe coronary calcification only in subjects withou established diabetes among Korean population.