Association of abdominal fat depots and insulin resistance in patients with coronary artery disease and metabolic syndrome

Aim. To evaluate the association between abdominal fat distribution and metabolic score of insulin resistance (IR) — Mets-IR, depending on the presence of metabolic syndrome (MS) in patients with stable coronary artery disease (CAD).

Material and methods. Sixty-one patients with chronic CAD. The significance of coronary atherosclerosis was determined using the Gensini Score. MS was defined according to the International Diabetes Federation criteria (2005). Abdominal magnetic resonance imaging (MRI) was performed at the L4-L5 level to determine the volume of abdominal fat depots. Blood glucose and insulin levels, lipid profile parameters, and adipokines were determined. Insulin resistance was assessed by calculating the homeostatic model assessment of IR (HOMA-IR) and Mets-I R.

Results. The MS group had significantly higher body mass indices and waist circumference, and between-group differences were found in glucose, serum leptin, and Mets-IR levels. In the MS group, abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) showed a strong correlation with Mets-I R. Patients with severe IR were characterized by increased VAT and SAT volumes; no difference in the VAT/SAT ratio was found. Body mass index, waist circumference, serum glucose, triglyceride, and high-sensitivity C-reactive protein levels were significantly higher, while high-density lipoprotein cholesterol levels were lower with greater IR severity.

Conclusion. The relationship between IR and abdominal adipose tissue volume varies depending on the severity of IR and differs depending on the presence of metabolic syndrome. Among individuals with chronic coronary artery disease (CAD), abdominal visceral obesity is associated with metabolic syndrome. The use of Mets-IR has demonstrated its validity in assessing IR in patients with CAD and metabolic syndrome, as well as a strong association with magnetic resonance imaging (MRI) parameters of abdominal fat depot volume.

1. Vaduganathan M, Mensah GA, Turco JV, et al. The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health. J Am Coll Cardiol. 2022;80(25):2361-71. doi:10.1016/j.jacc.2022.11.005.

2. Paiman EHM, de Mutsert R, Widya RL, et al. The role of insulin resistance in the relation of visceral, abdominal subcutaneous and total body fat to cardiovascular function. Nutr Metab Cardiovasc Dis. 2020;30(12):2230-41. doi:10.1016/j.numecd.2020. 07.011.

3. Nazare JA, Smith JD, Borel AL, et al. Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationship With Cardiometabolic Risk/Intra-Abdominal Adiposity. Am J Clin Nutr. 2012;96(4):714-26. doi: 10.3945/ajcn.112.035758.

4. Lavrenova EA, Drapkina OM. Insulin resistance in obesity: pathogenesis and effects. Obesity and metabolism. 2020;17(1):48-55. (In Russ.) doi:10.14341/omet9759.

5. Koshelskaya OA, Naryzhnaya NN, Kologrivova IV, et al. Correlation of epicardial adipocytes hypertrophy with adipokines, infl ammation and glucose and lipid metabolism. The Siberian Journal of Clinical and Experimental Medicine. 2023;38(1):64-74. (In Russ.) doi:10.29001/2073-8552-2023-38-1-65-75.

6. Preis SR, Massaro JM, Robins SJ, et al. Abdominal Subcutaneous and Visceral Adipose Tissue and Insulin Resistance in the Framingham Heart Study. Obesity. 2010;18(11):2191-8. doi:10.1038/oby.2010.59.

7. Machann J, Stefan N, Wagner R, et al. Normalized Indices Derived from Visceral Adipose Mass Assessed by Magnetic Resonance Imaging and Their Correlation with Markers for Insulin Resistance and Prediabetes. Nutrients. 2020;12(7):2064. doi:10.3390/nu12072064.

8. Tilves C, Zmuda JM, Kuipers AL, et al. Associations of Thigh and Abdominal Adipose Tissue Radiodensity with Glucose and Insulin in Nondiabetic African-Ancestry Men. Obesity (Silver Spring). 2020;28(2):404-11. doi:10.1002/oby.22695.

9. Yi W, Kim K, Im M, et al. Association between visceral adipose tissue volume, measured using computed tomography, and cardio-metabolic risk factors. Sci Rep. 2022;12(1):387. doi:10.1038/s41598-021-04402-5.

10. Gavrilova NE, Metelskaya VA, Perova NV, et al. Selection for the quantitative evaluation method of coronary arteries based upon comparative analysis of angiographic scales. Russian Journal of Cardiology. 2014;(6):24-9. (In Russ.) EDN: SHOXQB.

11. Mychka VB, Vertkin AL, Vardaev LI, et al. Experts’ consensus on the interdisciplinary approach towards the management, diagnostics, and treatment of patients with metabolic syndrome. Cardiovascular Therapy and Prevention. 2013;12(6):41-82. (In Russ.) М

12. Roytberg GE, Dorosh JV, Sharkhun OO, et al. New metabolic index use potentialities in evaluation of insulin resistance in clinical practice. Rational pharmacotherapy in cardiology. 2014;10(3):264-74. (In Russ.) doi:10.20996/1819-6446-2014-10-3-264-274.

13. Bello-Chavolla OY, Almeda-Valdes P, Gomez-Velasco D, et al. METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes. Eur J Endocrinol. 2018;178(5):533-44. doi:10.1530/EJE-17-0883.

14. Orekhov AYu, Karazhanova LK. The role of the sympathetic nervous system in resistant hypertension: pathophysiological and clinical aspects. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2022;28(4):348-56. (In Russ.) doi:10.18705/1607-419X-2022-28-4-348-356.

15. Belik EV, Gruzdeva OV. Insulin resistance: Unsolved issues of harm and use. Siberian Journal of Clinical and Experimental Medicine. 2019;34(4):39-48. (In Russ.)

16. Zhang QH, Xie LH, Zhang HN, et al. Magnetic resonance imaging assessment of abdominal ectopic fat deposition in correlation with cardiometabolic risk factors. Front Endocrinol (Lausanne). 2022;13:820023. doi:10.3389/fendo.2022.820023.

17. Garg UK, Mathur N, Sahlot R, et al. Abdominal fat depots and their association with insulin resistance in patients with type 2 diabetes. PLoS ONE. 2023;18(12):e0295492. doi:10.1371/ journal.pone.0295492.

18. Zyubanova IV, Ryumshina NI, Mordovin VF, et al. Relationships of the size of abdominal and perirenal fat depots with markers of meta-inflammatory and renal damage in patients with resistant hypertension. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2024;30(2):207-23. (In Russ.) doi:10.18705/1607-419X-2024-2318.

19. Hassan NE, El Hussieny MS, Abdel Rasheed E, El-Masry SA. Dispersal of Abdominal Visceral; Subcutaneous, Visceral to Subcutaneous Adiposity Ratio and Metabolic Syndrome in A Sample of Obese Egyptians. Eur J Clin Med. 2021;2(6):24-29. doi:10.24018/ejclinicmed.2021.2.6.124.

20. Liao C-C, Fujimoto WY, Kahn SE, et al. Abdominal visceral-tosubcutaneous fat ratio in the prediction of metabolic syndrome risk in Japanese Americans followed prospectively for 10-years loses information. Obesity Research & Clinical Practice. 2024; 18:263-8. doi:10.1016/j.orcp.2024.09.001.

21. Emamat H, Jamshidi A, Farhadi A, et al. The association between the visceral to subcutaneous abdominal fat ratio and the risk of cardiovascular diseases: a systematic review. BMC Public Health. 2024;24:1827. doi:10.1186/s12889-024-19358-0.

22. Martyushev-Poklad AV, Yankevich DS, Petrova MV, Savitskaya NG. Two models of insulin resistance development and the strategy to combat age-related diseases: literature review. Problems of Endocrinology. 2022;68(4):59-68. (In Russ.) doi:10.14341/probl13090.

23. Nurieva AR, Sineglazova AV. Obesity. Phenotypes and comorbidity in the early stages of the cardiometabolic continuum. The Bulletin of Contemporary Clinical Medicine. 2024;17(4):7-17. (In Russ.) doi:10.20969/VSKM.2024.17(4).7-17.

24. Demyanenko IA, Tkach AV. Functional morphology of adipose tissue and its role in the formation of metabolic syndrome. Krymskii zhurnal eksperimental’noy I klinicheskoy meditsynny. 2021;11(1):51-60. (In Russ.) doi:10.37279/2224-6444-2021-11-1-51-60.

25. Smirnova EN, Shulkina SG. Leptin, soluble leptin receptor, and free leptin index in patients with metabolic syndrome. Obesity and metabolism. 2017;14(1):30-4. (In Russ.) doi:10.14341/OMET2017130-34.

26. Ryumshina NI, Koshelskaya ОA, Naryzhnaya NV, et al. Visceral adipose tissue according to magnetic resonance imaging as a factor associated with leptin resistance in stable coronary artery disease. Cardiovascular Therapy and Prevention. 2025; 24(1):4236. (In Russ.) doi:10.15829/1728-8800-2025-4236