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Abstract：
BACKGROUND: Despite extensive research on body weight and cardiovascular risk, the mechanistic relationship between weight loss and coronary plaque modification has not been adequately addressed. This study aimed to determine the association between body composition dynamics and low-attenuation coronary plaque (LAP) burden.
METHODS: Eighty-nine participants (40% women, 60 ± 7.7 years) of the Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography (DISCO-CT) study with non-obstructive atherosclerosis with nonobstructive atherosclerosis confirmed in computed tomography angiography (CCTA), a randomized (1:1), prospective, single-center study were included into the analysis. Patients were randomly assigned to either experimental arm (intensive diet and lifestyle intervention atop optimal medical therapy, n = 45) or control arm (optimal medical therapy alone, n = 44) over 66.8 ± 13.7 weeks. Changes (∆) in body mass (BM) and body composition parameters, including total body fat (TBF), skeletal muscle mass (SMM), and fat-to-muscle ratio (FMR), measured with bioimpedance analyzer were compared with CCTA-measured ∆LAP. Coronary plaque analysis was performed using the 2 × 192 dual-energy scanner (Somatom Force, Siemens, Germany), while quantitative coronary plaque measurements were performed using a semi-automated plaque analysis software system (QAngioCT v3.1.3.13, Medis Medical Imaging Systems, Leiden, The Netherlands).
RESULTS: Significant intergroup differences were found for ∆BM (-3.6 ± 4.9 kg in the experimental vs. -1.4 ± 2.9 kg in the control group, p = 0.015), ∆TBF (-3.4 ± 4.8% in the experimental vs. 1.1 ± 5.5% in the control arm, p < 0.001), ∆SMM (1.9 ± 2.8% in the experimental vs. -0.7 ± 3.2% in the control arm, p < 0.001), and FMR [-12.9 (-21.2; -4.3)% in the experimental vs. 3.1 (-5.3; 10.7)% in the control arm, p < 0.001]. ∆LAP did not differ significantly between the study arms; however, in the whole study population, ∆LAP was positively correlated with ∆BM, ∆TBF, and ∆FMR (r = 0.45, p < 0.001; r = 0.300, p = 0.004; r = 0.233, p = 0.028, respectively), and negatively with ∆SMM (r = -0.285, p = 0.007). Multivariate linear regression analysis revealed the association of ∆LAP with ∆BM, ∆TBF, and ∆FMR.
CONCLUSIONS: The study intervention resulted in BM reduction characterized by fat loss, skeletal muscle gain, and increased FMR. This weight loss pattern may lead to a reduction in high-risk coronary plaque. Compared to a simple weight control, tracking body composition changes over time can provide valuable information on adverse coronary plaque modification.
METHODS: Eighty-nine participants (40% women, 60 ± 7.7 years) of the Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography (DISCO-CT) study with non-obstructive atherosclerosis with nonobstructive atherosclerosis confirmed in computed tomography angiography (CCTA), a randomized (1:1), prospective, single-center study were included into the analysis. Patients were randomly assigned to either experimental arm (intensive diet and lifestyle intervention atop optimal medical therapy, n = 45) or control arm (optimal medical therapy alone, n = 44) over 66.8 ± 13.7 weeks. Changes (∆) in body mass (BM) and body composition parameters, including total body fat (TBF), skeletal muscle mass (SMM), and fat-to-muscle ratio (FMR), measured with bioimpedance analyzer were compared with CCTA-measured ∆LAP. Coronary plaque analysis was performed using the 2 × 192 dual-energy scanner (Somatom Force, Siemens, Germany), while quantitative coronary plaque measurements were performed using a semi-automated plaque analysis software system (QAngioCT v3.1.3.13, Medis Medical Imaging Systems, Leiden, The Netherlands).
RESULTS: Significant intergroup differences were found for ∆BM (-3.6 ± 4.9 kg in the experimental vs. -1.4 ± 2.9 kg in the control group, p = 0.015), ∆TBF (-3.4 ± 4.8% in the experimental vs. 1.1 ± 5.5% in the control arm, p < 0.001), ∆SMM (1.9 ± 2.8% in the experimental vs. -0.7 ± 3.2% in the control arm, p < 0.001), and FMR [-12.9 (-21.2; -4.3)% in the experimental vs. 3.1 (-5.3; 10.7)% in the control arm, p < 0.001]. ∆LAP did not differ significantly between the study arms; however, in the whole study population, ∆LAP was positively correlated with ∆BM, ∆TBF, and ∆FMR (r = 0.45, p < 0.001; r = 0.300, p = 0.004; r = 0.233, p = 0.028, respectively), and negatively with ∆SMM (r = -0.285, p = 0.007). Multivariate linear regression analysis revealed the association of ∆LAP with ∆BM, ∆TBF, and ∆FMR.
CONCLUSIONS: The study intervention resulted in BM reduction characterized by fat loss, skeletal muscle gain, and increased FMR. This weight loss pattern may lead to a reduction in high-risk coronary plaque. Compared to a simple weight control, tracking body composition changes over time can provide valuable information on adverse coronary plaque modification.
摘要：
背景：尽管对体重和心血管风险进行了广泛的研究，体重减轻与冠状动脉斑块修饰之间的机制关系尚未得到充分解决.本研究旨在确定身体成分动力学与低衰减冠状动脉斑块（LAP）负担之间的关联。
方法：89名参与者（40%为女性，60±7.7年）的饮食干预在计算机断层扫描（DISCO-CT）研究中停止冠状动脉粥样硬化与非阻塞性动脉粥样硬化在计算机断层扫描血管造影（CCTA）中证实，随机（1：1），prospective,单中心研究纳入分析.患者被随机分配到任一实验臂(在最佳药物治疗的基础上进行强化饮食和生活方式干预,n=45）或控制臂（仅最佳药物治疗，n=44）超过66.8±13.7周。身体质量(BM)和身体成分参数的变化(Δ)，包括全身脂肪（TBF），骨骼肌质量（SMM），和脂肪肌肉比(FMR)，用生物阻抗分析仪测得的与CCTA测得的ΔLAP进行比较。使用2×192双能量扫描仪（SomatomForce，西门子,德国),而定量冠状动脉斑块测量是使用半自动斑块分析软件系统(QAngioCTv3.1.3.13，Medis医学成像系统，莱顿,荷兰）。
结果：发现了取决于BM的组间差异（实验中的-3.6±4.9kg与对照组-1.4±2.9kg，p=0.015),ΔTBF(-3.4±4.8%，在实验中与控制臂中的1.1±5.5％，p<0.001)，ΔSMM(实验中1.9±2.8%与控制臂中的-0.7±3.2%，p<0.001)，和FMR[-12.9(-21.2;-4.3)%在实验与控制臂中的3.1(-5.3;10.7)%,p<0.001]。ΔLAP在研究组之间没有显著差异；然而，在整个研究人群中，ΔLAP与ΔBM呈正相关，ΔTBF,和ΔFMR（分别为r=0.45，p<0.001；r=0.300，p=0.004；r=0.233，p=0.028），与ΔSMM呈负相关(r=-0.285，p=0.007)。多元线性回归分析揭示了ΔLAP与ΔBM的关联，ΔTBF,和ΔFMR。
结论：研究干预导致以脂肪减少为特征的BM减少，骨骼肌增重，增加FMR。这种体重减轻模式可能导致高风险冠状动脉斑块的减少。与简单的体重控制相比，跟踪身体成分随时间的变化可以提供有关不良冠状动脉斑块改变的有价值的信息.
方法：89名参与者（40%为女性，60±7.7年）的饮食干预在计算机断层扫描（DISCO-CT）研究中停止冠状动脉粥样硬化与非阻塞性动脉粥样硬化在计算机断层扫描血管造影（CCTA）中证实，随机（1：1），prospective,单中心研究纳入分析.患者被随机分配到任一实验臂(在最佳药物治疗的基础上进行强化饮食和生活方式干预,n=45）或控制臂（仅最佳药物治疗，n=44）超过66.8±13.7周。身体质量(BM)和身体成分参数的变化(Δ)，包括全身脂肪（TBF），骨骼肌质量（SMM），和脂肪肌肉比(FMR)，用生物阻抗分析仪测得的与CCTA测得的ΔLAP进行比较。使用2×192双能量扫描仪（SomatomForce，西门子,德国),而定量冠状动脉斑块测量是使用半自动斑块分析软件系统(QAngioCTv3.1.3.13，Medis医学成像系统，莱顿,荷兰）。
结果：发现了取决于BM的组间差异（实验中的-3.6±4.9kg与对照组-1.4±2.9kg，p=0.015),ΔTBF(-3.4±4.8%，在实验中与控制臂中的1.1±5.5％，p<0.001)，ΔSMM(实验中1.9±2.8%与控制臂中的-0.7±3.2%，p<0.001)，和FMR[-12.9(-21.2;-4.3)%在实验与控制臂中的3.1(-5.3;10.7)%,p<0.001]。ΔLAP在研究组之间没有显著差异；然而，在整个研究人群中，ΔLAP与ΔBM呈正相关，ΔTBF,和ΔFMR（分别为r=0.45，p<0.001；r=0.300，p=0.004；r=0.233，p=0.028），与ΔSMM呈负相关(r=-0.285，p=0.007)。多元线性回归分析揭示了ΔLAP与ΔBM的关联，ΔTBF,和ΔFMR。
结论：研究干预导致以脂肪减少为特征的BM减少，骨骼肌增重，增加FMR。这种体重减轻模式可能导致高风险冠状动脉斑块的减少。与简单的体重控制相比，跟踪身体成分随时间的变化可以提供有关不良冠状动脉斑块改变的有价值的信息.
