Increased volume of epicardial fat is an independent risk factor for accelerated progression of sub-clinical coronary atherosclerosis

• Published in: Atherosclerosis Vol. 220; no. 1; pp. 223 - 230
• Main Authors: Yerramasu, Ajay, Dey, Damini, Venuraju, Shreenidhi, Anand, Dhakshinamurthy Vijay, Atwal, Satvir, Corder, Roger, Berman, Daniel S., Lahiri, Avijit
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.01.2012; Elsevier
• Subjects: adipose tissue; Adipose Tissue - diagnostic imaging; Analysis of Variance; Asymptomatic Diseases; atherosclerosis; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; body mass index; calcium; Cardiology. Vascular system; Cardiovascular; computer software; confidence interval; Coronary Angiography; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary atherosclerosis; Coronary calcium score; Coronary heart disease; coronary vessels; Diabetes Mellitus; Diabetes Mellitus - diagnostic imaging; Diabetes Mellitus - epidemiology; Disease Progression; Epicardial adipose tissue; epidemiology; Female; Heart; Humans; image analysis; London; London - epidemiology; Male; males; Medical sciences; Metabolic syndrome; Metabolic Syndrome - diagnostic imaging; Metabolic Syndrome - epidemiology; methods; Middle Aged; Multivariate Analysis; obesity; odds ratio; pathogenesis; patients; Pericardial fat; Pericardium; Pericardium - diagnostic imaging; Predictive Value of Tests; Prevalence; Prospective Studies; radiography; Regression Analysis; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Tomography, X-Ray Computed; Vascular Calcification; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology; visceral fat; London; Pericardial fat; CAC; Coronary atherosclerosis; CAD; OPG; VAT; IQR; Metabolic syndrome; HU; Coronary artery disease; IL-6; Epicardial adipose tissue; Coronary calcium score; EAT; hs-CRP; coronary artery disease; coronary artery calcium; interquartile range; interleukin 6; epicardial adipose tissue; Hounsfield units; high sensitivity C reactive protein; osteoprotegerin; visceral adipose tissue; Endocrinopathy; Adipose tissue; Calcium; Metabolic diseases; Cardiovascular disease; Inorganic element; Coronary heart disease; Pericardium; Vascular disease; Atherosclerosis; Risk factor
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2011.09.041

Epicardial adipose tissue (EAT), a metabolically active visceral fat depot surrounding the heart, has been implicated in the pathogenesis of coronary artery disease (CAD) through possible paracrine interaction with the coronary arteries. We examined the association of EAT with metabolic syndrome and the prevalence and progression of coronary artery calcium (CAC) burden. CAC scan was performed in 333 asymptomatic diabetic patients without prior history of CAD (median age 54 years, 62% males), followed by a repeat scan after 2.7±0.3 years. CAC progression was defined as >2.5mm3 increase in square root transformed volumetric CAC scores. EAT and intra-thoracic fat volumes were quantified using a dedicated software (QFAT), and were examined in relation to the metabolic syndrome, baseline CAC scores and CAC progression. Both epicardial and intra-thoracic fat were associated with metabolic syndrome after adjustment for conventional cardiovascular risk factors, but the association was attenuated after additional adjustment for body mass index. EAT, but not intra-thoracic fat, showed significant association with baseline CAC scores (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.04–1.22, p=0.04) and CAC progression (OR 1.12, 95% CI 1.05–1.19, p<0.001) after adjustment for conventional measures of obesity and risk factors. EAT volume measured on non-contrast CT is an independent marker for the presence and severity of coronary calcium burden and also identifies individuals at increased risk of CAC progression. EAT quantification may thus add to the prognostic value of CAC imaging.