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It has been demonstrated that the vascular risk associated with obesity is particularly correlated with visceral fat. Visceral fat has been shown to secrete more inflammatory cytokines than subcutaneous fat. Inflammatory cytokines, such as interleukin-6, tumor necrosis factor-α, macrophage chemoattractant protein-1, and resistin, induce local and generalized inflammation and may also affect vascular disease [1]. The coronary artery calcium score (CACS) has been shown to predict future cardiovascular events [2]. Previous studies have shown that abdominal obesity is significantly correlated with CACS [3,4]. However, since there are differences in body composition across ethnic groups, it is unclear if such associations are also present in different populations.  In this context, I read with great interest the recent article titled "The Relationship of Body Composition and Coronary Artery Calcification in Apparently Healthy Korean Adults" by Yu et al. [5] published in March in the Journal. The authors clearly demonstrated that abdominal obesity as assessed by waist hip ratio is the most significant predictor for CACS in apparently healthy Korean adults. This finding is important, since this is the first demonstration of such an association in a Korean population. More interestingly, they also suggested a contrasting effect of body composition on CACS between genders. Male subjects showed a negative correlation between lean body mass and CACS, while females showed a positive correlation between body fat mass and CACS. However, the authors did not state whether they conducted logistic regression analyses separately for men and women. In my opinion, it would have added more value to their findings if they demonstrated such differences between genders after adjusting for other confounding variables. Another point that should be mentioned is that other metabolic parameters such as blood pressure, total cholesterol, and triglyceride included in the logistic regression analyses were found to not be significant factors for CACS. However, caution should be exercised when interpreting this result. As the authors already mentioned, details on subjects' medical history, including medication use, were not available for the analyses. It is plausible that a significant proportion of the subjects were using medication to control hypertension or hyperlipidemia, which may be why such metabolic parameters were found to be insignificant in the analyses.

endocrinology and metabolism

Letter: The Relationship of Body Composition and Coronary Artery Calcification in Apparently Healthy Korean Adults (Endocrinol Metab 2013;28:33-40, Jung-Hee Yu et al.)