Factor-64 Study: BMI may predict CVD risk in type 2 diabetes

DALLAS—Measurements of BMI independently predicted greater total coronary plaque and soft plaque among patients with diabetes, according to data presented at AHA 2013.

The landmark, randomized Factor-64 Study was initiated to determine the efficacy of CT scans as a screening method for cardiovascular disease in asymptomatic patients with diabetes, according to a press release.

“Our study shows there’s a strong linear relationship between BMI and plaque volume and composition,” Joseph B. Muhlestein, MD, co-director of CV research at the Intermountain Medical Center Heart Institute in Murray, UT, said in a press release. “So even being a little overweight is associated with more plaque, while being obese is associated with a lot of plaque.”

The researchers carried out univariate and multivariate analyses of plaque volume index (PVI) and soft plaque composition (SPC) on 224 patients and found that the mean PVI was 11.2 mm2; the mean SPC was 18.1%, according to data.

Coronary CT angiography (CCTA) is a noninvasive method for quantitative plaque analysis, but still lacks validation, according to abstract data.

“It may be that in diabetic patients without any symptoms of heart disease, their BMI could be used to determine if they need a CT scan to screen for plaque buildup,” Muhlestein said. “We could then develop a treatment plan for at-risk patients.”

The proximal coronary artery PVI displayed a stronger correlation to traditional risk factors (age: r=0.26 vs. 0.18) compared with full coronary PVI (LDL: r=0.12 vs. 0.06). In addition, proximal PVI appeared more accelerated (6.4 minutes vs. 22.8 minutes, P<.0001; and equally reproducible (ICC=0.96 vs. 0.95) vs. full PVI, according to data.

Researchers identified predictors of PVI by multivariate analysis as: age (8 years, P<.0001); male gender (P<.0001); duration of diabetes (P=.03); and BMI (P<.0001).

They also identified independent predictors for SPC as: age (8 years, P=.002); duration of diabetes (P=.02); and BMI (P=.002).

These findings have clinical implications regarding the future of how diabetes patients are treated with insulin, according to a press release.

“When you provide more insulin, it’s associated in almost every study with increased weight gain,” Muhlestein said.

Based on these data, Muhlestein said choosing insulin-sensitizing therapy as the primary management strategy might be a beneficial way to treat patients with diabetes without increasing BMI.

For more information:

Kwan AC. Abstract #15070. Presented at: the American Heart Association Scientific Sessions; Nov. 16-20, 2013; Dallas.

Disclosure: Muhlestein reports research grants from Toshiba and Bracco for the Factor-64 Study.