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Published in: The International Journal of Cardiovascular Imaging 4/2016

01-04-2016 | Original Paper

Epicardial fat thickness: distribution and association with diabetes mellitus, hypertension and the metabolic syndrome in the ELSA-Brasil study

Authors: Daniela Bertol Graeff, Murilo Foppa, Julio Cesar Gall Pires, Alvaro Vigo, Maria Ines Schmidt, Paulo Andrade Lotufo, Jose Geraldo Mill, Bruce Bartholow Duncan

Published in: The International Journal of Cardiovascular Imaging | Issue 4/2016

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Abstract

Epicardial fat thickness (EFT) has emerged as a marker of cardiometabolic risk, but its clinical use warrants proper knowledge of its distribution and associations in populations. We aimed to describe the distribution of EFT, its demographic correlates and independent associations with diabetes, hypertension and metabolic syndrome (MS) in free-living Brazilian adults. From the baseline echocardiography of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)—a cohort study of civil servants aged 35–74 years—EFT was measured from a randomly selected sample of 998 participants as the mean of two paraesternal windows obtained at end systole (EFTsyst) and end diastole (EFTdiast). From the 421 individuals free of diabetes, hypertension and MS, we defined EFT reference values and the EFTsyst 75th percentile cut-off. Median EFTsyst was 1.5 (IQR 0–2.6) mm; a large proportion (84 %) had EFTdiast = 0. EFT was higher in women and lower in blacks, and increased with age and BMI. Although EFT was higher in those with diabetes, hypertension, and MS, EFT associations were reduced when adjusted for age, sex and ethnicity, and were non-significant after adjusting for obesity measures. In conclusion, the amount of EFT in this large multiethnic population is smaller than reported in other populations. EFT reference values varied across demographic and clinical variables, EFT associations with cardiometabolic variables being largely explained by age, sex, ethnicity and central obesity. Although EFT can help identify individuals at increased cardiometabolic risk, it will likely have a limited additional role compared to current risk stratification strategies.
Literature
1.
5.
go back to reference Nelson MR, Mookadam F, Thota V et al (2011) Epicardial fat: an additional measurement for subclinical atherosclerosis and cardiovascular risk stratification? J Am Soc Echocardiogr 24:339–345CrossRefPubMed Nelson MR, Mookadam F, Thota V et al (2011) Epicardial fat: an additional measurement for subclinical atherosclerosis and cardiovascular risk stratification? J Am Soc Echocardiogr 24:339–345CrossRefPubMed
13.
go back to reference Gottdiener JS, Bednarz J, Devereux R et al (2004) American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 17:1086–1119PubMed Gottdiener JS, Bednarz J, Devereux R et al (2004) American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 17:1086–1119PubMed
14.
go back to reference Mancia G, De Backer G, Dominiczak A et al (2007) 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 28:1462–1536. doi:10.1093/eurheartj/ehm236 PubMed Mancia G, De Backer G, Dominiczak A et al (2007) 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 28:1462–1536. doi:10.​1093/​eurheartj/​ehm236 PubMed
15.
go back to reference Alberti KGMM, Eckel RH, Grundy SM et al (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120:1640–1645. doi:10.1161/CIRCULATIONAHA.109.192644 CrossRefPubMed Alberti KGMM, Eckel RH, Grundy SM et al (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120:1640–1645. doi:10.​1161/​CIRCULATIONAHA.​109.​192644 CrossRefPubMed
16.
go back to reference Lai Y-H, Yun C-H, Yang F-S et al (2012) Epicardial adipose tissue relating to anthropometrics, metabolic derangements and fatty liver disease independently contributes to serum high-sensitivity C-reactive protein beyond body fat composition: a study validated with computed tomography. J Am Soc Echocardiogr 25:234–241. doi:10.1016/j.echo.2011.09.018 CrossRefPubMed Lai Y-H, Yun C-H, Yang F-S et al (2012) Epicardial adipose tissue relating to anthropometrics, metabolic derangements and fatty liver disease independently contributes to serum high-sensitivity C-reactive protein beyond body fat composition: a study validated with computed tomography. J Am Soc Echocardiogr 25:234–241. doi:10.​1016/​j.​echo.​2011.​09.​018 CrossRefPubMed
17.
go back to reference Pierdomenico SD, Pierdomenico AM, Neri M, Cuccurullo F (2011) Epicardial adipose tissue and metabolic syndrome in hypertensive patients with normal body weight and waist circumference. Am J Hypertens 24:1245–1249. doi:10.1038/ajh.2011.134 CrossRefPubMed Pierdomenico SD, Pierdomenico AM, Neri M, Cuccurullo F (2011) Epicardial adipose tissue and metabolic syndrome in hypertensive patients with normal body weight and waist circumference. Am J Hypertens 24:1245–1249. doi:10.​1038/​ajh.​2011.​134 CrossRefPubMed
19.
go back to reference Iacobellis G, Ribaudo MC, Assael F et al (2003) Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 88:5163–5168CrossRefPubMed Iacobellis G, Ribaudo MC, Assael F et al (2003) Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 88:5163–5168CrossRefPubMed
23.
go back to reference Alexopoulos N, McLean DS, Janik M et al (2010) Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis 210:150–154CrossRefPubMed Alexopoulos N, McLean DS, Janik M et al (2010) Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis 210:150–154CrossRefPubMed
26.
go back to reference Psaltis PJ, Talman AH, Munnur K et al (2015) Relationship between epicardial fat and quantitative coronary artery plaque progression: insights from computer tomography coronary angiography. Int J Cardiovasc Imaging. doi:10.1007/s10554-015-0762-3 PubMed Psaltis PJ, Talman AH, Munnur K et al (2015) Relationship between epicardial fat and quantitative coronary artery plaque progression: insights from computer tomography coronary angiography. Int J Cardiovasc Imaging. doi:10.​1007/​s10554-015-0762-3 PubMed
30.
go back to reference Beasley LE, Koster A, Newman AB et al (2009) Inflammation and race and gender differences in computerized tomography-measured adipose depots. Obes Silver Spring Md 17:1062–1069. doi:10.1038/oby.2008.627 CrossRef Beasley LE, Koster A, Newman AB et al (2009) Inflammation and race and gender differences in computerized tomography-measured adipose depots. Obes Silver Spring Md 17:1062–1069. doi:10.​1038/​oby.​2008.​627 CrossRef
31.
go back to reference Carroll JF, Fulda KG, Chiapa AL et al (2009) Impact of race/ethnicity on the relationship between visceral fat and inflammatory biomarkers. Obes Silver Spring Md 17:1420–1427. doi:10.1038/oby.2008.657 Carroll JF, Fulda KG, Chiapa AL et al (2009) Impact of race/ethnicity on the relationship between visceral fat and inflammatory biomarkers. Obes Silver Spring Md 17:1420–1427. doi:10.​1038/​oby.​2008.​657
32.
go back to reference McClain J, Hsu F, Brown E et al (2013) Pericardial adipose tissue and coronary artery calcification in the Multi-ethnic Study of Atherosclerosis (MESA). Obes Silver Spring Md 21:1056–1063. doi:10.1002/oby.20090 CrossRef McClain J, Hsu F, Brown E et al (2013) Pericardial adipose tissue and coronary artery calcification in the Multi-ethnic Study of Atherosclerosis (MESA). Obes Silver Spring Md 21:1056–1063. doi:10.​1002/​oby.​20090 CrossRef
33.
go back to reference Hartiala O, Magnussen CG, Bucci M et al (2015) Coronary heart disease risk factors, coronary artery calcification and epicardial fat volume in the Young Finns Study. Eur Heart J Cardiovasc Imaging 16:1256–1263. doi:10.1093/ehjci/jev085 CrossRefPubMed Hartiala O, Magnussen CG, Bucci M et al (2015) Coronary heart disease risk factors, coronary artery calcification and epicardial fat volume in the Young Finns Study. Eur Heart J Cardiovasc Imaging 16:1256–1263. doi:10.​1093/​ehjci/​jev085 CrossRefPubMed
34.
go back to reference Tanami Y, Jinzaki M, Kishi S et al (2015) 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 8:e002676. doi:10.1161/CIRCIMAGING.114.002676 CrossRefPubMedPubMedCentral Tanami Y, Jinzaki M, Kishi S et al (2015) 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 8:e002676. doi:10.​1161/​CIRCIMAGING.​114.​002676 CrossRefPubMedPubMedCentral
35.
go back to reference Rosito GA, Massaro JM, Hoffmann U et al (2008) Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample. Circulation 117:605–613CrossRefPubMed Rosito GA, Massaro JM, Hoffmann U et al (2008) Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample. Circulation 117:605–613CrossRefPubMed
36.
go back to reference Ding J, Kritchevsky SB, Hsu F-C et al (2008) Association between non-subcutaneous adiposity and calcified coronary plaque: a substudy of the multi-ethnic study of atherosclerosis. Am J Clin Nutr 88:645–650PubMedPubMedCentral Ding J, Kritchevsky SB, Hsu F-C et al (2008) Association between non-subcutaneous adiposity and calcified coronary plaque: a substudy of the multi-ethnic study of atherosclerosis. Am J Clin Nutr 88:645–650PubMedPubMedCentral
41.
go back to reference Skelton TN, Andrew ME, Arnett DK et al (2003) Echocardiographic left ventricular mass in African-Americans: the Jackson cohort of the Atherosclerosis Risk in Communities Study. Echocardiography 20:111–120CrossRefPubMed Skelton TN, Andrew ME, Arnett DK et al (2003) Echocardiographic left ventricular mass in African-Americans: the Jackson cohort of the Atherosclerosis Risk in Communities Study. Echocardiography 20:111–120CrossRefPubMed
Metadata
Title
Epicardial fat thickness: distribution and association with diabetes mellitus, hypertension and the metabolic syndrome in the ELSA-Brasil study
Authors
Daniela Bertol Graeff
Murilo Foppa
Julio Cesar Gall Pires
Alvaro Vigo
Maria Ines Schmidt
Paulo Andrade Lotufo
Jose Geraldo Mill
Bruce Bartholow Duncan
Publication date
01-04-2016
Publisher
Springer Netherlands
Published in
The International Journal of Cardiovascular Imaging / Issue 4/2016
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-015-0810-z

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