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Change in Abdominal Obesity & Risk of Coronary Calcification

Change in Abdominal Obesity & Risk of Coronary Calcification. Siamak Sabour, MD, MSc, DSc, PhD, Postdoc Clinical Epidemiologist Persian International Epidemiology Network (PIEPNET). SCIENTIFIC BACKGROUND. 1994: M.D , I.R. Iran 2004: M.Sc, Clinical Epidemiology , Erasmus MC, The Netherlands

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Change in Abdominal Obesity & Risk of Coronary Calcification

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  1. Change in Abdominal Obesity & Risk of Coronary Calcification Siamak Sabour, MD, MSc, DSc, PhD, Postdoc Clinical Epidemiologist Persian International Epidemiology Network (PIEPNET)

  2. SCIENTIFIC BACKGROUND • 1994:M.D, I.R. Iran • 2004:M.Sc, Clinical Epidemiology, Erasmus MC, The Netherlands • 2006:D.Sc, Clinical Epidemiology, Erasmus MC, The Netherlands • 2007:Ph.D, Clinical Epidemiology, UMC Utrecht, The Netherlands • 2008 • Post doc Cardiovascular Epidemiology Thomas Jefferson University, Philadelphia, PA, USA • Post doc Pharmacoepidemiology University of Pennsylvania, Philadelphia, PA, USA • 2008 until now Assistant Prof of Clinical Epidemiology & Medicine Sabour S, MD, MSc, DSc, PhD, Postdoc

  3. Introduction • Obesity is a major health problem in industrialized countries. • The prevalence of overweight and obesity has increased dramatically in last decades. Sabour S, MD, MSc, DSc, PhD, Postdoc

  4. Introduction • Visceral or abdominal obesity is an important indicator of cardiovascular risk. • Atherosclerosis is a key factor in the pathogenesis of cardiovascular disease. Sabour S, MD, MSc, DSc, PhD, Postdoc

  5. Introduction • Atherosclerosis in the coronary arteries (CAC) can be accurately and reproducibly assessed with Multi-Detector Computed Tomography (MDCT) in a non-invasive way. Sabour S, MD, MSc, DSc, PhD, Postdoc

  6. Introduction • CAC is increasingly used as a marker of disease risk or of subclinical atherosclerosis. • The presence of CAC is a significant predictor of subsequent cardiovascular disease and total mortality. Sabour S, MD, MSc, DSc, PhD, Postdoc

  7. Introduction • Randomized Controlled Trials (RCT) have indicated that weight loss may benefit levels of risk factors; however, trials were usually of modest duration. Sabour S, MD, MSc, DSc, PhD, Postdoc

  8. PURPOSE • To determine the impact of change in abdominal obesity, as assessed by change in WHR during 9 years, on risk of coronary artery calcification (CAC). Sabour S, MD, MSc, DSc, PhD, Postdoc

  9. DESIGN Cohort (longitudinal) study Sabour S, MD, MSc, DSc, PhD, Postdoc

  10. SUBJECTS 573 postmenopausal women selected from a population based cohort study. (PROSPECT study) Sabour S, MD, MSc, DSc, PhD, Postdoc

  11. METHODS Data on WHR were collected at baseline (1993-1997) and follow-up (2002-2004). At follow-up, the women underwent a multi-detector computed tomography (MDCT) (Philips Mx 8000 IDT16) to assess coronary artery calcium (CAC). Sabour S, MD, MSc, DSc, PhD, Postdoc

  12. Sabour S, MD, MSc, DSc, PhD, Postdoc

  13. Sabour S, MD, MSc, DSc, PhD, Postdoc

  14. METHODS The Agatston score was used to quantify coronary artery calcium. Logistic regression models were used to evaluate the relations under study. Sabour S, MD, MSc, DSc, PhD, Postdoc

  15. METHODS Change in WHR was categorized into four groups: • Low at baseline - Low at follow-up (Low was defined as below the median) • High-Low • Low-High • High-High Sabour S, MD, MSc, DSc, PhD, Postdoc

  16. RESULTS • Compared to subjects whose WHR remained below the median of the distribution at both occasions, those with a WHR above the medianat both occasions had a 2.7 [95% CI 1.8-4.0] fold increased risk of CAC. Sabour S, MD, MSc, DSc, PhD, Postdoc

  17. RESULTS • Women whose WHR rose over the 9 year period from below the median to above the median had a 2.5 [95%CI 1.4-4.5] fold increased risk of CAC. Sabour S, MD, MSc, DSc, PhD, Postdoc

  18. General characteristics of study population (n=573) Low Density Lipoprotein, High Density Lipoprotein § Based on systolic, diastolic and history of having hypertension in baseline questionnaire Sabour S, MD, MSc, DSc, PhD, Postdoc

  19. Sabour S, MD, MSc, DSc, PhD, Postdoc

  20. Risk of coronary calcification in categories of change in obesity markers (BMI, WC, HC and WHR) Model 1= Adjusted for Age Model 2= Adjusted for Age and Smoking at baseline. Sabour S, MD, MSc, DSc, PhD, Postdoc

  21. CONCLUSION Persistent abdominal obesity as well as an increase in abdominal fat over time relates to an increased risk of coronary atherosclerosis. Sabour S, MD, MSc, DSc, PhD, Postdoc

  22. Acknowledgments Prof. Diederick. E. Grobbee, MD, PhD Prof. Mathias Prokop, MD, PhD Dr. Yvonne. T. van der Schouw, PhD Prof. Michiel. L. Bots, MD, PhD 1. Julius Centre, University Medical Centre Utrecht, The Netherlands 2. Radiology Department, University Medical Center Utrecht, The Netherlands Sabour S, MD, MSc, DSc, PhD, Postdoc

  23. CONCLUSION Changes in Waist-to-Hip Ratio (WHR) relates to an increased risk of CAC. However, Body Mass Index (BMI), has no effect on that.

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