The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Association of epicardial adipose tissue with metabolic risk factors on cardiovascular outcomes: serial coronary computed tomography angiography study

  • Sungjoon Park (Department of Internal Medicine, Seoul National University Hospital) ;
  • Dong Eun Kim (Seoul National University College of Medicine) ;
  • Su Min Kim (Seoul National University College of Medicine) ;
  • JungMin Choi (Department of Internal Medicine, Seoul National University Hospital) ;
  • Sang Joon Park (Research and Science Division, Research and Development Center, MEDICALIP Co. Ltd.) ;
  • Hae-Young Lee (Department of Internal Medicine, Seoul National University Hospital) ;
  • Eun Ju Chun (Division of Radiology, Seoul National University Bundang Hospital)
  • Received : 2023.09.18
  • Accepted : 2023.11.29
  • Published : 2024.03.01
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Abstract

Background/Aims: Epicardial adipose tissue (EAT) shares pathophysiological properties with other visceral fats and potentially triggers local inflammation. However, the association of EAT with cardiovascular disease (CVD) is still debatable. The study aimed to observe the changes and associations in EAT and risk factors over time, as well as to investigate whether EAT was associated with CVD. Methods: A total of 762 participants from Seoul National University Hospital (SNUH) and SNUH Gangnam Center were included in this study. EAT was measured using coronary computed tomography angiography. Results: Baseline EAT level was positively associated with body mass index (BMI), calcium score, atherosclerotic cardiovascular disease (ASCVD) 10-year risk score, glucose, triglycerides (TG)/high-density lipoprotein (HDL), but not with total cholesterol, low-density lipoprotein (LDL). At follow-up, EAT levels increased in all groups, with low EAT groups demonstrating a significant increase in EAT per year. Change in EAT was associated with a change in BMI, TG/HDL, and glucose, while changes in LDL, calcium score, and ASCVD 10-year risk score were not associated. Although calcium score and ASCVD 10-year risk score were associated with CVD events, baseline information of EAT, baseline EAT/body surface area, or EAT change was not available. Conclusions: Metabolic risks, e.g., BMI, TG/HDL, and glucose, were associated with EAT change per year, whereas classical CVD risks, e.g., LDL, calcium score, and ASCVD 10-year risk score, were not. The actual CVD event was not associated with EAT volume, warranting future studies combining qualitative assessments with quantitative ones.

Keywords

Acknowledgement

We thank Soo Yeon Shin and Kyung Min Jung for their technical assistance in the radiological assessment of EAT.

References

  1. Chang S, Lee W, Kwag B, Chung YH, Kang IS. Maximal pericoronary adipose tissue thickness is associated with hypertension in nonobese patients with acute or chronic illness. Korean J Intern Med 2017;32:668-674.  https://doi.org/10.3904/kjim.2016.118
  2. Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism 1987;36:54-59.  https://doi.org/10.1016/0026-0495(87)90063-1
  3. Cai X, Luo D, Liu S, et al. Four-year changes in central fatness, risk of diabetes, and metabolic control in older adults: a cohort study with mediation analysis. Korean J Intern Med 2022;37:230-240.  https://doi.org/10.3904/kjim.2020.629
  4. Lee HY, Despres JP, Koh KK. Perivascular adipose tissue in the pathogenesis of cardiovascular disease. Atherosclerosis 2013;230:177-184.  https://doi.org/10.1016/j.atherosclerosis.2013.07.037
  5. Bertaso AG, Bertol D, Duncan BB, Foppa M. Epicardial fat: definition, measurements and systematic review of main outcomes. Arq Bras Cardiol 2013;101:e18-e28.  https://doi.org/10.5935/abc.20130138
  6. Park SE, Park CY, Choi JM, et al. Depot-specific changes in fat metabolism with aging in a type 2 diabetic animal model. PLoS One 2016;11:e0148141. 
  7. Alexopoulos N, Raggi P. The importance of targeting epicardial adipose tissue to improve cardiovascular outcomes in diabetes mellitus. Atherosclerosis 2022;363:69-70.  https://doi.org/10.1016/j.atherosclerosis.2022.11.008
  8. Prati F, Arbustini E, Labellarte A, et al. Eccentric atherosclerotic plaques with positive remodelling have a pericardial distribution: a permissive role of epicardial fat? A three-dimensional intravascular ultrasound study of left anterior descending artery lesions. Eur Heart J 2003;24:329-336.  https://doi.org/10.1016/S0195-668X(02)00426-8
  9. Hogea T, Suciu BA, Ivanescu AD, et al. Increased epicardial adipose tissue (EAT), left coronary artery plaque morphology, and valvular atherosclerosis as risks factors for sudden cardiac death from a forensic perspective. Diagnostics (Basel) 2023;13:142. 
  10. Pezeshkian M, Noori M, Najjarpour-Jabbari H, et al. Fatty acid composition of epicardial and subcutaneous human adipose tissue. Metab Syndr Relat Disord 2009;7:125-131.  https://doi.org/10.1089/met.2008.0056
  11. Sacks HS, Fain JN, Holman B, et al. Uncoupling protein-1 and related messenger ribonucleic acids in human epicardial and other adipose tissues: epicardial fat functioning as brown fat. J Clin Endocrinol Metab 2009;94:3611-3615.  https://doi.org/10.1210/jc.2009-0571
  12. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005;2:536-543.  https://doi.org/10.1038/ncpcardio0319
  13. Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 2003;108:2460-2466.  https://doi.org/10.1161/01.CIR.0000099542.57313.C5
  14. Yudkin JS, Eringa E, Stehouwer CD. "Vasocrine" signalling from perivascular fat: a mechanism linking insulin resistance to vascular disease. Lancet 2005;365:1817-1820.  https://doi.org/10.1016/S0140-6736(05)66585-3
  15. Lu MT, Park J, Ghemigian K, et al. Epicardial and paracardial adipose tissue volume and attenuation - Association with high-risk coronary plaque on computed tomographic angiography in the ROMICAT II trial. Atherosclerosis 2016;251:47-54.  https://doi.org/10.1016/j.atherosclerosis.2016.05.033
  16. Kim TH, Yu SH, Choi SH, et al. Pericardial fat amount is an independent risk factor of coronary artery stenosis assessed by multidetector-row computed tomography: the Korean Atherosclerosis Study 2. Obesity (Silver Spring) 2011;19:1028-1034.  https://doi.org/10.1038/oby.2010.246
  17. Villasante Fricke AC, Iacobellis G. Epicardial adipose tissue: clinical biomarker of cardio-metabolic risk. Int J Mol Sci 2019;20:5989. 
  18. Rosito GA, Massaro JM, Hoffmann U, et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation 2008;117:605-613.  https://doi.org/10.1161/CIRCULATIONAHA.107.743062
  19. Mahabadi AA, Massaro JM, Rosito GA, et al. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J 2009;30:850-856.  https://doi.org/10.1093/eurheartj/ehn573
  20. Tesche C, Bauer MJ, Straube F, et al. Association of epicardial adipose tissue with coronary CT angiography plaque parameters on cardiovascular outcome in patients with and without diabetes mellitus. Atherosclerosis 2022;363:78-84.  https://doi.org/10.1016/j.atherosclerosis.2022.10.006
  21. Turer AT, Scherer PE. Adiponectin: mechanistic insights and clinical implications. Diabetologia 2012;55:2319-2326.  https://doi.org/10.1007/s00125-012-2598-x
  22. Wu Y, Zhang A, Hamilton DJ, Deng T. Epicardial fat in the maintenance of cardiovascular health. Methodist Debakey Cardiovasc J 2017;13:20-24.  https://doi.org/10.14797/mdcj-13-1-20
  23. Sicari R, Sironi AM, Petz R, et al. Pericardial rather than epicardial fat is a cardiometabolic risk marker: an MRI vs echo study. J Am Soc Echocardiogr 2011;24:1156-1162.  https://doi.org/10.1016/j.echo.2011.06.013
  24. Greif M, Becker A, von Ziegler F, et al. Pericardial adipose tissue determined by dual source CT is a risk factor for coronary atherosclerosis. Arterioscler Thromb Vasc Biol 2009;29:781-786.  https://doi.org/10.1161/ATVBAHA.108.180653
  25. Gorter PM, van Lindert AS, de Vos AM, et al. Quantification of epicardial and peri-coronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. Atherosclerosis 2008;197:896-903.  https://doi.org/10.1016/j.atherosclerosis.2007.08.016
  26. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827-832.  https://doi.org/10.1016/0735-1097(90)90282-T
  27. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;140:e563-e595.  https://doi.org/10.1161/CIR.0000000000000724
  28. Lee SE, Sung JM, Andreini D, et al. Association between changes in perivascular adipose tissue density and plaque progression. JACC Cardiovasc Imaging 2022;15:1760-1767.  https://doi.org/10.1016/j.jcmg.2022.04.016
  29. Wassel CL, Laughlin GA, Araneta MR, et al. Associations of pericardial and intrathoracic fat with coronary calcium presence and progression in a multiethnic study. Obesity (Silver Spring) 2013;21:1704-1712.  https://doi.org/10.1002/oby.20111
  30. Tanami Y, Jinzaki M, Kishi S, et al. Lack of association between epicardial fat volume and extent of coronary artery calcification, severity of coronary artery disease, or presence of myocardial perfusion abnormalities in a diverse, symptomatic patient population: results from the CORE320 multicenter study. Circ Cardiovasc Imaging 2015;8:e002676.