Contribution of visceral fat accumulation to the development of coronary artery disease in non-obese men

Associations between intra-abdominal visceral fat accumulations and coronary risk factors were studied in a sample of 29 non-obese men aged 57 ± 10 years with coronary artery disease (CAD). Their body mass indexes (BMI) were 23.8 ± 1.5 (range 18.7–26.3). The visceral fat area (VFA) and the subcutaneous fat area (SFA) were measured at the level of the umbilicus by computed tomography. In patients with CAD, the average VFA was significantly increased compared with that in 54 control subjects without CAD, matched for sex, age, and BMI (117.2 ± 53.1 vs. 93.8 ± 38.6 cm2, P < 0.05). However, their average SFA was not statistically different (111.2 ± 33.3 vs. 106.3 ± 35.7 cm2, N.S.). Eleven CAD patients (38%) and nine control subjects (17%) had greater than 2S. D. higher than the mean VFA obtained from 22 healthy subjects extracted from the control subjects. Accordingly, the proportion of the subjects with high VFA was significantly higher in the CAD group. This group also had significantly higher levels of plasma glucose and insulin areas than controls determined by oral glucose tolerance tests. This may be due to insulin resistance. The proportion of the subjects with multiple risk factors including hyperlipidemia, hyperglycemia, and hypertension was significantly higher in the CAD patients with high VFA compared with the control subjects with normal VFA (CAD with high VFA 82% and control with normal VFA 33%). These findings suggest that visceral fat accumulations may play an important role in the occurrence of CAD regardless of obesity. Accordingly, we propose the term ‘visceral fat syndrome’, which encompasses visceral fat accumulation, glucose intolerance, hyperlipidemia, and hypertension. Patients with this syndrome have increased susceptibility to coronary sclerosis from these risk factors based on visceral fat accumulation.