Epicardial Adipose Tissue Volume and Adipocytokine Imbalance Are Strongly Linked to Human Coronary Atherosclerosis (original) (raw)
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Epicardial adipose tissue is an independent predictor of coronary atherosclerotic burden
2011
Introduction: Epicardial adipose tissue (EAT) may play an active role in the development of coronary artery disease (CAD). The aim of this work was to study the relations between EAT, abdominal visceral fat (AVF), and coronary atherosclerotic burden as assessed by multislice computed tomography (MSCT). Population and methods: Two hundred fifteen patients without known CAD referred to 64-SCT during a 6-months period were included. All patients underwent a standardized protocol including quantification of AVF, EAT, coronary artery calcification (CAC), and coronary angiography by MSCT. Results: Two hundred fifteen patients, with mean age of 58 ± 11 years, in which 61% were males, with mean body mass index (BMI) of 28 ± 4 kg/m 2 were included. EAT volume was directly associated with male sex, age, BMI, abdominal circumference, AVF, number of coronary segments with atherosclerotic plaques (p b 0.01 for all), number of segments with significant stenoses, and presence of metabolic syndrome components (p b 0.05). CAC increased by 14.7% per additional 10 ml of EAT volume. Adjusting for age, gender, and AVF changed this increase to 7.5%. After adjusting for all considered confounders, there was still an independent association, with a CAC increase of 3.7% per additional 10 ml of EAT. A significant interaction was found between EAT volume and gender and between EAT volume and obesity: an increase of EAT was associated with an increase of additional 8% of CAC in men, and additional increase of 5% in non-obese individuals (p b 0.001 for both). Conclusion: EAT volume positively relates to coronary atherosclerotic burden, as assessed by CAC; this correlation was shown to be independent of AVF.
Atherosclerosis, 2014
Background: Increased-epicardial-adipose tissue (EAT) is associated with the presence and severity of subclinical-atherosclerosis. This study investigates the long-term clinical-outcome of subjects with and without increased-EAT. Methods: Two hundred and forty-five subjects, aged 61 ± 9 years and 34% women underwent clinically-indicated computed-tomography-angiography (CTA), and body-surfacearea adjusted EAT was measured and were followed prospectively. CTA-diagnosed coronary-arterydisease (CAD) was defined as obstructive (luminal-stenosis !50%), non-obstructive (luminal-stenosis: 1 e49%) and zero-obstruction. Major-adverse-cardiac-event (MACE) was defined as myocardial-infarction or cardiovascular-death. Results: EAT increased significantly from subjects with zero-obstructioncoronaries (93 ± 37 cm 3 /m 2) to non-obstructive-CAD (132 ± 25 cm 3 /m 2) to obstructive-CAD (145 ± 35 cm 3 /m 2) (P ¼ 0.01). During the 48-month follow-up, the event-rate was 8.6% (21). The event free survival-rate decreased significantly from 99% in the lowest-quartile to 86.6% in the highestquartile of EAT. After adjustment for risk-factors, the hazard ratio of MACE was 1.4, 3.1 and 5.7 in lower mid-, upper mid-and highest-quartiles of EAT as compared to lowest-quartile of EAT (P < 0.05). Conclusion: Increased EAT is directly associated with CAD and predicts MACE independent of the age, gender and conventional-risk-factors.
Association between coronary atherosclerosis and visceral adiposity index
Nutrition, Metabolism and Cardiovascular Diseases
Background and aims: Visceral obesity is a marker of dysfunctional adipose tissue and ectopic fat infiltration. Many studies have shown that visceral fat dysfunction has a close relationship with cardiovascular disease. For a better identification of visceral adiposity dysfunction, the visceral adiposity index (VAI) is used. Coronary artery calcium score (CACS) is known to have a strong correlation with the total plaque burden therefore provides information about the severity of the coronary atherosclerosis. CACS is a strong predictor of cardiac events and it refines cardiovascular risk assessment beyond conventional risk factors. Our aim was to evaluate the association between VAI and CACS in an asymptomatic Caucasian population. Methods and results: Computed tomography scans of 460 participants were analyzed in a crosssectional, voluntary screening program. A health questionnaire, physical examination and laboratory tests were also performed. Participants with a history of cardiovascular disease were excluded from the analysis. Mean VAI was 1.41 AE 0.07 in men and 2.00 AE 0.15 in women. VAI showed a positive correlation with total coronary calcium score (r Z 0.242) in males but not in females. VAI was stratified into tertiles by gender. In males, third VAI tertile was independently associated with CACS>100 (OR: 3.21, p Z 0.02) but not with CACS>0 after the effects of conventional risk factors were eliminated. Conclusion: VAI tertiles were associated with calcium scores and the highest VAI tertile was an independent predictor for the presence of CACS>100 in males but not in females.
Visceral adiposity index and 10-year cardiovascular disease incidence: The ATTICA study
Nutrition, Metabolism and Cardiovascular Diseases, 2017
Background/Aims: Visceral adiposity index (VAI) has been proposed as a marker of visceral adipose tissue accumulation/dysfunction. Our aim was to evaluate potential associations between the VAI and the 10-year cardiovascular disease (CVD) incidence. Methods and Results: During 2001-2002, 3042 Greek adults (1514 men; age: ≥ 18 years) without previous CVD were recruited into the ATTICA study, whilst the 10-year study follow-up was performed in 2011-2012, recording the fatal/nonfatal CVD incidence in 2020 (1010 men) participants. The baseline VAI scores for these participants were calculated based on anthropometric and lipid variables, while VAI tertiles were extracted for further analyses. During the study follow-up a total of 317 CVD events (15.7%) were observed. At baseline, the participants' age and the prevalence of hypertension, diabetes, hypercholesterolemia and metabolic syndrome increased significantly across the VAI tertiles. After adjusting for multiple confounders, VAI exhibited a significantly independent positive association with the 10-year CVD incidence (OR= 1.05, 95%CI: 1.01, 1.10), whereas the association of the body mass index (HR= 1.03, 95%CI: 0.99, 1.08), or the waist circumference (HR= 1.01, 95%CI: 0.99, 1.02) was less prominent. Sex-specific analysis further showed that VAI remained significantly predictive of CVD in men alone (HR= 1.06, 95%CI: 1.00, 1.11) but not in women (HR= 1.06, 95%CI: 0.96, 1.10). Conclusions: Our findings show for the first time in a large-sample, long-term, prospective study in Europe that the VAI is independently associated with elevated 10-year CVD risk, particularly in men. This suggests that the VAI may be utilized as an additional indicator of long-term CVD risk for Caucasian/Mediterranean men without previous CVD.
Journal of The American Society of Echocardiography, 2011
The value of epicardial adipose tissue (EAT) thickness as determined by echocardiography in cardiovascular risk assessment is not well understood. The aim of this study was to determine the associations between EAT thickness and Framingham risk score, carotid intima media thickness, carotid artery plaque, and computed tomographic coronary calcium score in a primary prevention population.Patients presenting for cardiovascular preventive care (n = 356) who underwent echocardiography as well as carotid artery ultrasound and/or coronary calcium scoring were included.EAT thickness was weakly correlated with Framingham risk score. The prevalence of carotid plaque was significantly greater in those with EAT thickness ≥5.0 mm who either had low Framingham risk scores or had body mass indexes ≥25 kg/m2, compared with those with EAT thickness <5.0 mm. No significant association between EAT thickness and carotid intima-media thickness or coronary calcium score existed.EAT thickness ≥5.0 mm may identify an individual with a higher likelihood of having detectable carotid atherosclerosis.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology
Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot that plays an important role in coronary atherosclerosis. In this study, our aim was to investigate the relationship between long-term major adverse cardiovascular events (MACEs) and EAT volume detected by coronary computed tomography angiography (CCTA) in patients with Type 2 diabetes mellitus (T2-DM) without previous coronary events. Methods: A total of 127 patients with diabetes who underwent CCTA between 2012 and 2014 were enrolled retrospectively. The study population was divided into 2 groups according to whether they experienced or did not experience MACE, which was defined as cardiac death, non-fatal myocardial infarction or unstable angina requiring hospitalization, coronary revascularizations (percutaneous coronary intervention or coronary artery bypass grafting surgery), heart failure, peripheral arterial disease, or ischemic stroke. In both groups, EAT volumes were measured by CCTA. Results: During 60±7 months follow-up period, 22 participants experienced MACEs. Data were evaluated with univariate and multivariate analyses and receiver operating characteristic (ROC) analysis. Age, male sex, coronary artery disease, hemoglobin A1c, glucose, creatinine, C-reactive protein, and cholesterol levels were found to be associated with MACE. EAT volume (odds ratio [OR]: 1.027; 95% confidence interval [CI]: 1.010-1.044, p=0.002) and low-density lipoprotein (OR: 1.015; 95% CI: 1.000-1.030, p=0.050) were found to be independent predictors for MACE. ROC analysis indicated that EAT volumes >123.2 mL had a 72.7% sensitivity and a 77.1% specificity for predicting long-term MACE in patients with T2-DM (area under the curve: 0.820; 95% CI: 0.733-0.908). Conclusion: EAT volume is an independent predictor of long-term MACE in patients with T2-DM without previous coronary events. EAT volume may be used additionally in risk stratification for MACE besides the well-known vascular risk factors in patients with T2-DM. Amaç: Epikardiyal yağ dokusu (EYD) koroner aterosklerozda önemli rol oynayan metabolik olarak aktif viseral yağ deposudur. Çalışmamızda amacımız koroner olay geçirmemiş tip 2 diyabetik (T2-DM) hastalarda uzun dönem majör istenmeyen kardiyovasküler olay (MİKO) ile koroner bilgisayarlı tomografi anjiyografi (KBTA) ile ölçülen EYD hacim ilişkisini değerlendirmektir. Yöntemler: 2012-2014 yılları arasında KBTA yapılmış toplam 127 diyabetik hasta retrospektif olarak çalışmaya dahil edildi. Hastalar MİKO varlığına göre iki gruba ayrıldı. MİKO kardiyak ölüm, hastane yatışı gerektiren ölümcül olmayan miyokart enfarktüsü ya da kararsız angina, koroner revaskülarizasyon (perkütan koroner girişim, koroner arter baypas greftleme cerrahisi), kalp yetersizliği, periferik arter hastalığı, iskemik inme olarak tanımlandı. İki grubun EYD hacmi KBTA ile ölçüldü. Bulgular: 60±7 aylık takip süresinde 22 MİKO tespit edildi. Tek ve çok değişkenli analizler ve alıcı işlem karakteristiği (ROC) analizi ile veriler değerlendirildi. Yaş, erkek cinsiyet, koroner arter hastalığı, hemoglobin A1c, glukoz, kreatinin, C-reaktif protein (CRP) ve kolesterol kan düzeyleri MİKO ile ilişkili bulundu. EYD hacmi (OR: 1.027; %95 GA: 1.010-1.044, p: 0.002) ve düşük dansiteli (yoğunluklu) lipoprotein (OR: 1.015; 95% CI: 1.000-1.030, p: 0.050) MİKO için bağımsız öngördürücü olarak bulundu. ROC analiz sonucuna göre 123.2 mL üzerinde EYD hacmi, %72.7 duyarlılık ve %77.1 özgüllük ile T2-DM hastalarında uzun dönem MİKO'yu öngördürür (Eğri altındaki alan: 0.820; %95 CI: 0.733-0.908). Sonuç: EYD hacmi, öncesinde koroner olay geçirmemiş T2-DM hastalarda uzun dönem MİKO'yu bağımsız olarak öngördürebilmektedir. EYD hacmi T2-DM hastalarda iyi bilinen vasküler risk faktörleri yanı sıra risk sınıflamasında ek olarak kullanılabilir.
Associations of indices of adiposity with atherogenic lipoprotein subfractions
International Journal of Obesity, 1998
OBJECTIVE: To investigate the associations of indices of adiposity with cardiovascular risk factors. SUBJECTS: 93 men and 98 women aged 18±69 y. OUTCOME MEASURES: Body mass index (BMI), waist to hip ratio (WHR), waist circumference, waist to height ratio, blood pressure, fasting concentrations of blood glucose, insulin, plasma lipids and lipoprotein subfractions, apoproteins, lipoprotein(a) and post-heparin lipases. RESULTS: BMI and waist showed similar associations (P`0.01) with a cluster of major cardiovascular risk factors including total cholesterol, low density lipoprotein-cholesterol and very low density lipoprotein-cholesterol in men, and ratio of low density lipoprotein-ahigh density lipoprotein-cholesterol for both genders. Large waist circumference was signi®cantly (P`0.01) associated (controlled for age and smoking) with features of the metabolic syndrome, including raised insulin concentration (men: r 0.37, women: r 0.49), reduced high density lipoprotein 2 (men: r 0.30, women: r 0.34), increased very low density lipoprotein 1 mass (men: r 0.31, women: r 0.42), raised small, dense low density lipoprotein (men: r 0.30, women: r 0.31), elevated blood pressure (men: r 0.27, women: r 0.28), increased triglyceride (men: r 0.43, women: r 0.48) and apolipoprotein-B (men: r 0.32, women: r 0.35). Waist circumference also correlated with hepatic lipasealipoprotein lipase ratio in women (r 0.52). Height adjustment did not substantially change relationships between waist circumference and risk factors. WHR correlated with fewer risk factors. CONCLUSION: For the purpose of health promotion to prevent cardiovascular disease associated with overweight and intra-abdominal fat accumulation, the general public should be advised to be aware of the risk associated with large waist circumference.
Clinical Endocrinology, 2009
Epicardial adipose tissue (EAT) is a part of visceral fat deposited around the heart between the pericardium and myocardium along the distribution of coronary arteries. EAT thickness is reported to be associated with coronary atherosclerosis; however, no study has measured EAT volume in patients with type 2 diabetes or investigate its association with coronary artery disease. A hospital-based case control study. A total of 49 patients with type 2 diabetes mellitus (T2DM) and 78 nondiabetic controls were studied. Cardiac multislice computed tomography was used to measure EAT volume, Gensini score, coronary artery calcium score and, coronary lesions. The relationships between EAT volume, markers of coronary atherosclerosis and anthropometric and biochemical parameters of metabolic syndrome (MetS) were investigated. EAT volume was significantly higher in patients with T2DM than in nondiabetic subjects (166.1 +/- 60.6 cm(3) vs. 123.4 +/- 41.8 cm(3), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Logistic regression analysis revealed independent and significant associations between EAT and diabetic status. EAT volume was significantly associated with components of MetS (BMI, waist circumference, fasting serum glucose, total cholesterol, HDL-cholesterol, and triglycerides levels), Gensini score, coronary lesions, coronary disease and coronary calcium scores. Univariate, multivariate and trend analyses confirmed that EAT volume was associated with MetS component clustering and the coronary atherosclerosis index. The analytical results indicate that EAT volume is increased in T2DM patients and is associated with unfavourable components of MetS and coronary atherosclerosis. The close anatomical relationship between EAT and the coronary arteries, combined with other evidence indicating that EAT is a biologically active adipokine-secreting tissue, suggest that EAT participates in the pathogenesis of diabetic coronary atherosclerosis.
Bangladesh Heart Journal, 2017
Background: Ischemic Heart Disease (IHD) is the leading cause of death throughout the world and obesity especially visceral adiposity (central obesity has significant influence for its development & progression. Visceral adiposity index (VAI) is a novel sex specific index which had significant correlation with visceral adiposity.Objectives: To evaluate the impact of cut-off points of VAI defining visceral adipose dysfunction (VAD) on the angiographic severity of coronary artery disease in patients of IHD.Methods: A total of 100 patients with IHD were divided into Case (of which 50 patients of IHD with VAD positive) and Control group (of which 50 patients of IHD with VAD negative). Then clinical, biochemical, echocardiographic and coronary artery angiographic indexes (determined by Gensini score) were acquired in relation to VAI.Results: VAD positive group had more significant form of coronary artery disease in term of Gensini score than VAD negative group.The mean level of Visceral ...