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Published in: BMC Cardiovascular Disorders 1/2018

Open Access 01-12-2018 | Research article

Epicardial adipose tissue is related to arterial stiffness and inflammation in patients with cardiovascular disease and type 2 diabetes

Authors: Shaween Al-Talabany, Ify Mordi, J. Graeme Houston, Helen M. Colhoun, Jonathan R. Weir-McCall, Shona Z. Matthew, Helen C. Looker, Daniel Levin, Jill J. F. Belch, Fiona Dove, Faisel Khan, Chim C. Lang

Published in: BMC Cardiovascular Disorders | Issue 1/2018

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Abstract

Background

Epicardial adipose tissue (EAT) is an emerging cardio-metabolic risk factor and has been shown to correlate with adverse cardiovascular (CV) outcome; however the underlying pathophysiology of this link is not well understood. The aim of this study was to evaluate the relationship between EAT and a comprehensive panel of cardiovascular risk biomarkers and pulse wave velocity (PWV) and indexed left ventricular mass (LVMI) in a cohort of patients with cardiovascular disease (CVD) and diabetes compared to controls.

Methods

One hundred forty-five participants (mean age 63.9 ± 8.1 years; 61% male) were evaluated. All patients underwent cardiovascular magnetic resonance (CMR) examination and PWV. EAT measurements from CMR were performed on the 4-chamber view. Blood samples were taken and a range of CV biomarkers was evaluated.

Results

EAT measurements were significantly higher in the groups with CVD, with or without T2DM compared to patients without CVD or T2DM (group 1 EAT 15.9 ± 5.5 cm2 vs. group 4 EAT 11.8 ± 4.1 cm2, p = 0.001; group 3 EAT 15.1 ± 4.3 cm2 vs. group 4 EAT 11.8 ± 4.1 cm2, p = 0.024). EAT was independently associated with IL-6 (beta 0.2, p = 0.019). When added to clinical variables, both EAT (beta 0.16, p = 0.035) and IL-6 (beta 0.26, p = 0.003) were independently associated with PWV. EAT was significantly associated with LVMI in a univariable analysis but not when added to significant clinical variables.

Conclusions

In patients with cardio-metabolic disease, EAT was independently associated with PWV. EAT may be associated with CVD risk due to an increase in systemic vascular inflammation. Whether targeting EAT may reduce inflammation and/or cardiovascular risk should be evaluated in prospective studies.
Appendix
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Literature
1.
go back to reference Despres JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126(10):1301–13.CrossRefPubMed Despres JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126(10):1301–13.CrossRefPubMed
2.
go back to reference Britton KA, Massaro JM, Murabito JM, Kreger BE, Hoffmann U, Fox CS. Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol. 2013;62(10):921–5.CrossRefPubMedPubMedCentral Britton KA, Massaro JM, Murabito JM, Kreger BE, Hoffmann U, Fox CS. Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol. 2013;62(10):921–5.CrossRefPubMedPubMedCentral
3.
go back to reference Mahabadi AA, Berg MH, Lehmann N, Kalsch H, Bauer M, Kara K, Dragano N, Moebus S, Jockel KH, Erbel R, et al. Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol. 2013;61(13):1388–95.CrossRefPubMed Mahabadi AA, Berg MH, Lehmann N, Kalsch H, Bauer M, Kara K, Dragano N, Moebus S, Jockel KH, Erbel R, et al. Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol. 2013;61(13):1388–95.CrossRefPubMed
4.
go back to reference Iacobellis G. Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol. 2015;11(6):363–71.CrossRefPubMed Iacobellis G. Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol. 2015;11(6):363–71.CrossRefPubMed
5.
go back to reference Karastergiou K, Evans I, Ogston N, Miheisi N, Nair D, Kaski JC, Jahangiri M, Mohamed-Ali V. Epicardial adipokines in obesity and coronary artery disease induce atherogenic changes in monocytes and endothelial cells. Arterioscler Thromb Vasc Biol. 2010;30(7):1340–6.CrossRefPubMed Karastergiou K, Evans I, Ogston N, Miheisi N, Nair D, Kaski JC, Jahangiri M, Mohamed-Ali V. Epicardial adipokines in obesity and coronary artery disease induce atherogenic changes in monocytes and endothelial cells. Arterioscler Thromb Vasc Biol. 2010;30(7):1340–6.CrossRefPubMed
6.
go back to reference Shimabukuro M, Hirata Y, Tabata M, Dagvasumberel M, Sato H, Kurobe H, Fukuda D, Soeki T, Kitagawa T, Takanashi S, et al. Epicardial adipose tissue volume and adipocytokine imbalance are strongly linked to human coronary atherosclerosis. Arterioscler Thromb Vasc Biol. 2013;33(5):1077–84.CrossRefPubMed Shimabukuro M, Hirata Y, Tabata M, Dagvasumberel M, Sato H, Kurobe H, Fukuda D, Soeki T, Kitagawa T, Takanashi S, et al. Epicardial adipose tissue volume and adipocytokine imbalance are strongly linked to human coronary atherosclerosis. Arterioscler Thromb Vasc Biol. 2013;33(5):1077–84.CrossRefPubMed
7.
go back to reference Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H, Sarov-Blat L, O'Brien S, Keiper EA, Johnson AG, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108(20):2460–6.CrossRefPubMed Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H, Sarov-Blat L, O'Brien S, Keiper EA, Johnson AG, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108(20):2460–6.CrossRefPubMed
8.
go back to reference Baker AR, Silva NF, Quinn DW, Harte AL, Pagano D, Bonser RS, Kumar S, McTernan PG. Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol. 2006;5:1.CrossRefPubMedPubMedCentral Baker AR, Silva NF, Quinn DW, Harte AL, Pagano D, Bonser RS, Kumar S, McTernan PG. Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol. 2006;5:1.CrossRefPubMedPubMedCentral
9.
go back to reference Hatem SN, Redheuil A, Gandjbakhch E. Cardiac adipose tissue and atrial fibrillation: the perils of adiposity. Cardiovasc Res. 2016;109(4):502–9.CrossRefPubMed Hatem SN, Redheuil A, Gandjbakhch E. Cardiac adipose tissue and atrial fibrillation: the perils of adiposity. Cardiovasc Res. 2016;109(4):502–9.CrossRefPubMed
10.
go back to reference Bos D, Shahzad R, van Walsum T, van Vliet LJ, Franco OH, Hofman A, Niessen WJ, Vernooij MW, van der Lugt A. Epicardial fat volume is related to atherosclerotic calcification in multiple vessel beds. Eur Heart J Cardiovasc Imaging. 2015;16(11):1264–9.CrossRefPubMed Bos D, Shahzad R, van Walsum T, van Vliet LJ, Franco OH, Hofman A, Niessen WJ, Vernooij MW, van der Lugt A. Epicardial fat volume is related to atherosclerotic calcification in multiple vessel beds. Eur Heart J Cardiovasc Imaging. 2015;16(11):1264–9.CrossRefPubMed
11.
go back to reference Iacobellis G, Bianco AC. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab. 2011;22(11):450–7.CrossRefPubMedPubMedCentral Iacobellis G, Bianco AC. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab. 2011;22(11):450–7.CrossRefPubMedPubMedCentral
12.
go back to reference Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen J. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006;113(5):664–70.CrossRefPubMed Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen J. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006;113(5):664–70.CrossRefPubMed
13.
go back to reference Choi TY, Ahmadi N, Sourayanezhad S, Zeb I, Budoff MJ. Relation of vascular stiffness with epicardial and pericardial adipose tissues, and coronary atherosclerosis. Atherosclerosis. 2013;229(1):118–23.CrossRefPubMed Choi TY, Ahmadi N, Sourayanezhad S, Zeb I, Budoff MJ. Relation of vascular stiffness with epicardial and pericardial adipose tissues, and coronary atherosclerosis. Atherosclerosis. 2013;229(1):118–23.CrossRefPubMed
14.
go back to reference Natale F, Tedesco MA, Mocerino R, de Simone V, Di Marco GM, Aronne L, Credendino M, Siniscalchi C, Calabro P, Cotrufo M, et al. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiogr. 2009;10(4):549–55.CrossRefPubMed Natale F, Tedesco MA, Mocerino R, de Simone V, Di Marco GM, Aronne L, Credendino M, Siniscalchi C, Calabro P, Cotrufo M, et al. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiogr. 2009;10(4):549–55.CrossRefPubMed
15.
go back to reference Duce SL, Weir-McCall JR, Gandy SJ, Matthew SZ, Cassidy DB, McCormick L, Rauchhaus P, Looker H, Colhoun HM, Houston JG. Cohort comparison study of cardiac disease and atherosclerotic burden in type 2 diabetic adults using whole body cardiovascular magnetic resonance imaging. Cardiovasc Diabetol. 2015;14:122.CrossRefPubMedPubMedCentral Duce SL, Weir-McCall JR, Gandy SJ, Matthew SZ, Cassidy DB, McCormick L, Rauchhaus P, Looker H, Colhoun HM, Houston JG. Cohort comparison study of cardiac disease and atherosclerotic burden in type 2 diabetic adults using whole body cardiovascular magnetic resonance imaging. Cardiovasc Diabetol. 2015;14:122.CrossRefPubMedPubMedCentral
16.
go back to reference Kessels K, Cramer MJ, Velthuis B. Epicardial adipose tissue imaged by magnetic resonance imaging: an important risk marker of cardiovascular disease. Heart. 2006;92(7):962.CrossRefPubMedPubMedCentral Kessels K, Cramer MJ, Velthuis B. Epicardial adipose tissue imaged by magnetic resonance imaging: an important risk marker of cardiovascular disease. Heart. 2006;92(7):962.CrossRefPubMedPubMedCentral
17.
go back to reference Graner M, Nyman K, Siren R, Pentikainen MO, Lundbom J, Hakkarainen A, Lauerma K, Lundbom N, Nieminen MS, Taskinen MR. Ectopic fat depots and left ventricular function in nondiabetic men with nonalcoholic fatty liver disease. Circ Cardiovasc Imaging. 2015;8(1):7–14. Graner M, Nyman K, Siren R, Pentikainen MO, Lundbom J, Hakkarainen A, Lauerma K, Lundbom N, Nieminen MS, Taskinen MR. Ectopic fat depots and left ventricular function in nondiabetic men with nonalcoholic fatty liver disease. Circ Cardiovasc Imaging. 2015;8(1):7–14.
18.
go back to reference Graner M, Siren R, Nyman K, Lundbom J, Hakkarainen A, Pentikainen MO, Lauerma K, Lundbom N, Adiels M, Nieminen MS, et al. Cardiac steatosis associates with visceral obesity in nondiabetic obese men. J Clin Endocrinol Metab. 2013;98(3):1189–97.CrossRefPubMed Graner M, Siren R, Nyman K, Lundbom J, Hakkarainen A, Pentikainen MO, Lauerma K, Lundbom N, Adiels M, Nieminen MS, et al. Cardiac steatosis associates with visceral obesity in nondiabetic obese men. J Clin Endocrinol Metab. 2013;98(3):1189–97.CrossRefPubMed
19.
go back to reference Nyman K, Graner M, Pentikainen MO, Lundbom J, Hakkarainen A, Siren R, Nieminen MS, Taskinen MR, Lundbom N, Lauerma K. Cardiac steatosis and left ventricular function in men with metabolic syndrome. J Cardiovasc Magn Reson. 2013;15:103.CrossRefPubMedPubMedCentral Nyman K, Graner M, Pentikainen MO, Lundbom J, Hakkarainen A, Siren R, Nieminen MS, Taskinen MR, Lundbom N, Lauerma K. Cardiac steatosis and left ventricular function in men with metabolic syndrome. J Cardiovasc Magn Reson. 2013;15:103.CrossRefPubMedPubMedCentral
20.
go back to reference Heiberg E, Sjogren J, Ugander M, Carlsson M, Engblom H, Arheden H. Design and validation of segment--freely available software for cardiovascular image analysis. BMC Med Imaging. 2010;10:1.CrossRefPubMedPubMedCentral Heiberg E, Sjogren J, Ugander M, Carlsson M, Engblom H, Arheden H. Design and validation of segment--freely available software for cardiovascular image analysis. BMC Med Imaging. 2010;10:1.CrossRefPubMedPubMedCentral
21.
go back to reference Shore AC, Colhoun HM, Natali A, Palombo C, Ostling G, Aizawa K, Kennback C, Casanova F, Persson M, Gooding K, et al. Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study. J Intern Med. 2015;278(3):291–302.CrossRefPubMed Shore AC, Colhoun HM, Natali A, Palombo C, Ostling G, Aizawa K, Kennback C, Casanova F, Persson M, Gooding K, et al. Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study. J Intern Med. 2015;278(3):291–302.CrossRefPubMed
22.
go back to reference Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, Asmar R, Reneman RS, Hoeks AP, Breteler MM, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam study. Circulation. 2006;113(5):657–63.CrossRefPubMed Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, Asmar R, Reneman RS, Hoeks AP, Breteler MM, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam study. Circulation. 2006;113(5):657–63.CrossRefPubMed
23.
go back to reference Kim BJ, Kim BS, Kang JH. Echocardiographic epicardial fat thickness is associated with arterial stiffness. Int J Cardiol. 2013;167(5):2234–8.CrossRefPubMed Kim BJ, Kim BS, Kang JH. Echocardiographic epicardial fat thickness is associated with arterial stiffness. Int J Cardiol. 2013;167(5):2234–8.CrossRefPubMed
24.
go back to reference Sunbul M, Agirbasli M, Durmus E, Kivrak T, Akin H, Aydin Y, Ergelen R, Yilmaz Y. Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness. Atherosclerosis. 2014;237(2):490–3.CrossRefPubMed Sunbul M, Agirbasli M, Durmus E, Kivrak T, Akin H, Aydin Y, Ergelen R, Yilmaz Y. Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness. Atherosclerosis. 2014;237(2):490–3.CrossRefPubMed
25.
go back to reference Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation. 2004;109(21 Suppl 1):II2–10.PubMed Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation. 2004;109(21 Suppl 1):II2–10.PubMed
26.
go back to reference Ong KL, Ding J, McClelland RL, Cheung BM, Criqui MH, Barter PJ, Rye KA, Allison MA. Relationship of pericardial fat with biomarkers of inflammation and hemostasis, and cardiovascular disease: the multi-ethnic study of atherosclerosis. Atherosclerosis. 2015;239(2):386–92.CrossRefPubMedPubMedCentral Ong KL, Ding J, McClelland RL, Cheung BM, Criqui MH, Barter PJ, Rye KA, Allison MA. Relationship of pericardial fat with biomarkers of inflammation and hemostasis, and cardiovascular disease: the multi-ethnic study of atherosclerosis. Atherosclerosis. 2015;239(2):386–92.CrossRefPubMedPubMedCentral
27.
go back to reference Ding J, Hsu FC, Harris TB, Liu Y, Kritchevsky SB, Szklo M, Ouyang P, Espeland MA, Lohman KK, Criqui MH, et al. The association of pericardial fat with incident coronary heart disease: the multi-ethnic study of atherosclerosis (MESA). Am J Clin Nutr. 2009;90(3):499–504.CrossRefPubMedPubMedCentral Ding J, Hsu FC, Harris TB, Liu Y, Kritchevsky SB, Szklo M, Ouyang P, Espeland MA, Lohman KK, Criqui MH, et al. The association of pericardial fat with incident coronary heart disease: the multi-ethnic study of atherosclerosis (MESA). Am J Clin Nutr. 2009;90(3):499–504.CrossRefPubMedPubMedCentral
28.
go back to reference Tadros TM, Massaro JM, Rosito GA, Hoffmann U, Vasan RS, Larson MG, Keaney JF Jr, Lipinska I, Meigs JB, Kathiresan S, et al. Pericardial fat volume correlates with inflammatory markers: the Framingham heart study. Obesity (Silver Spring). 2010;18(5):1039–45.CrossRef Tadros TM, Massaro JM, Rosito GA, Hoffmann U, Vasan RS, Larson MG, Keaney JF Jr, Lipinska I, Meigs JB, Kathiresan S, et al. Pericardial fat volume correlates with inflammatory markers: the Framingham heart study. Obesity (Silver Spring). 2010;18(5):1039–45.CrossRef
29.
go back to reference Maghbooli Z, Hossein-Nezhad A. Transcriptome and molecular endocrinology aspects of Epicardial adipose tissue in cardiovascular diseases: a systematic review and meta-analysis of observational studies. Biomed Res Int. 2015;2015:926567.CrossRefPubMedPubMedCentral Maghbooli Z, Hossein-Nezhad A. Transcriptome and molecular endocrinology aspects of Epicardial adipose tissue in cardiovascular diseases: a systematic review and meta-analysis of observational studies. Biomed Res Int. 2015;2015:926567.CrossRefPubMedPubMedCentral
30.
go back to reference Salazar J, Luzardo E, Mejias JC, Rojas J, Ferreira A, Rivas-Rios JR, Bermudez V. Epicardial fat: physiological, pathological, and therapeutic implications. Cardiol Res Pract. 2016;2016:1291537.CrossRefPubMedPubMedCentral Salazar J, Luzardo E, Mejias JC, Rojas J, Ferreira A, Rivas-Rios JR, Bermudez V. Epicardial fat: physiological, pathological, and therapeutic implications. Cardiol Res Pract. 2016;2016:1291537.CrossRefPubMedPubMedCentral
31.
go back to reference Klouche M, Bhakdi S, Hemmes M, Rose-John S. Novel path to activation of vascular smooth muscle cells: up-regulation of gp130 creates an autocrine activation loop by IL-6 and its soluble receptor. J Immunol. 1999;163(8):4583–9.PubMed Klouche M, Bhakdi S, Hemmes M, Rose-John S. Novel path to activation of vascular smooth muscle cells: up-regulation of gp130 creates an autocrine activation loop by IL-6 and its soluble receptor. J Immunol. 1999;163(8):4583–9.PubMed
32.
go back to reference Wolf D, Jehle F, Michel NA, Bukosza EN, Rivera J, Chen YC, Hoppe N, Dufner B, Rodriguez AO, Colberg C, et al. Coinhibitory suppression of T cell activation by CD40 protects against obesity and adipose tissue inflammation in mice. Circulation. 2014;129(23):2414–25.CrossRefPubMed Wolf D, Jehle F, Michel NA, Bukosza EN, Rivera J, Chen YC, Hoppe N, Dufner B, Rodriguez AO, Colberg C, et al. Coinhibitory suppression of T cell activation by CD40 protects against obesity and adipose tissue inflammation in mice. Circulation. 2014;129(23):2414–25.CrossRefPubMed
33.
go back to reference Missiou A, Wolf D, Platzer I, Ernst S, Walter C, Rudolf P, Zirlik K, Kostlin N, Willecke FK, Munkel C, et al. CD40L induces inflammation and adipogenesis in adipose cells--a potential link between metabolic and cardiovascular disease. Thromb Haemost. 2010;103(4):788–96.CrossRefPubMed Missiou A, Wolf D, Platzer I, Ernst S, Walter C, Rudolf P, Zirlik K, Kostlin N, Willecke FK, Munkel C, et al. CD40L induces inflammation and adipogenesis in adipose cells--a potential link between metabolic and cardiovascular disease. Thromb Haemost. 2010;103(4):788–96.CrossRefPubMed
34.
go back to reference Fosshaug LE, Dahl CP, Risnes I, Bohov P, Berge RK, Nymo S, Geiran O, Yndestad A, Gullestad L, Aukrust P, et al. Altered levels of fatty acids and inflammatory and metabolic mediators in Epicardial adipose tissue in patients with systolic heart failure. J Card Fail. 2015;21(11):916–23.CrossRefPubMed Fosshaug LE, Dahl CP, Risnes I, Bohov P, Berge RK, Nymo S, Geiran O, Yndestad A, Gullestad L, Aukrust P, et al. Altered levels of fatty acids and inflammatory and metabolic mediators in Epicardial adipose tissue in patients with systolic heart failure. J Card Fail. 2015;21(11):916–23.CrossRefPubMed
35.
go back to reference Bakkum MJ, Danad I, Romijn MA, Stuijfzand WJ, Leonora RM, Tulevski II, Somsen GA, Lammertsma AA, van Kuijk C, van Rossum AC, et al. The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function. Eur J Nucl Med Mol Imaging. 2015;42(10):1562–73.CrossRefPubMedPubMedCentral Bakkum MJ, Danad I, Romijn MA, Stuijfzand WJ, Leonora RM, Tulevski II, Somsen GA, Lammertsma AA, van Kuijk C, van Rossum AC, et al. The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function. Eur J Nucl Med Mol Imaging. 2015;42(10):1562–73.CrossRefPubMedPubMedCentral
36.
go back to reference Gates PE, Gentile CL, Seals DR, Christou DD. Adiposity contributes to differences in left ventricular structure and diastolic function with age in healthy men. J Clin Endocrinol Metab. 2003;88(10):4884–90.CrossRefPubMed Gates PE, Gentile CL, Seals DR, Christou DD. Adiposity contributes to differences in left ventricular structure and diastolic function with age in healthy men. J Clin Endocrinol Metab. 2003;88(10):4884–90.CrossRefPubMed
37.
go back to reference Fox CS, Gona P, Hoffmann U, Porter SA, Salton CJ, Massaro JM, Levy D, Larson MG, D’Agostino RB Sr, O'Donnell CJ, et al. Pericardial fat, intrathoracic fat, and measures of left ventricular structure and function: the Framingham heart study. Circulation. 2009;119(12):1586–91.CrossRefPubMedPubMedCentral Fox CS, Gona P, Hoffmann U, Porter SA, Salton CJ, Massaro JM, Levy D, Larson MG, D’Agostino RB Sr, O'Donnell CJ, et al. Pericardial fat, intrathoracic fat, and measures of left ventricular structure and function: the Framingham heart study. Circulation. 2009;119(12):1586–91.CrossRefPubMedPubMedCentral
Metadata
Title
Epicardial adipose tissue is related to arterial stiffness and inflammation in patients with cardiovascular disease and type 2 diabetes
Authors
Shaween Al-Talabany
Ify Mordi
J. Graeme Houston
Helen M. Colhoun
Jonathan R. Weir-McCall
Shona Z. Matthew
Helen C. Looker
Daniel Levin
Jill J. F. Belch
Fiona Dove
Faisel Khan
Chim C. Lang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2018
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-018-0770-z

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