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

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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.

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References

  1. Sacks HS, Fain JN (2007) Human epicardial adipose tissue: a review. Am Heart J 153:907–917

    Article  CAS  PubMed  Google Scholar 

  2. Iacobellis G, Willens HJ (2009) Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 22:1311–1319. doi:10.1016/j.echo.2009.10.013

    Article  PubMed  Google Scholar 

  3. Pierdomenico SD, Pierdomenico AM, Cuccurullo F, Iacobellis G (2013) Meta-analysis of the relation of echocardiographic epicardial adipose tissue thickness and the metabolic syndrome. Am J Cardiol 111:73–78. doi:10.1016/j.amjcard.2012.08.044

    Article  PubMed  Google Scholar 

  4. Iacobellis G, Assael F, Ribaudo MC et al (2003) Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 11:304–310. doi:10.1038/oby.2003.45

    Article  PubMed  Google Scholar 

  5. 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 24:339–345

    Article  PubMed  Google Scholar 

  6. Verhagen SN, Visseren FLJ (2011) Perivascular adipose tissue as a cause of atherosclerosis. Atherosclerosis 214:3–10. doi:10.1016/j.atherosclerosis.2010.05.034

    Article  CAS  PubMed  Google Scholar 

  7. Guzzardi MA, Iozzo P (2011) Fatty heart, cardiac damage, and inflammation. Rev Diabet Stud RDS 8:403–417. doi:10.1900/RDS.2011.8.403

    Article  PubMed  Google Scholar 

  8. Yudkin JS, Eringa E, Stehouwer CDA (2005) “Vasocrine” signalling from perivascular fat: a mechanism linking insulin resistance to vascular disease. Lancet 365:1817–1820. doi:10.1016/S0140-6736(05)66585-3

    Article  PubMed  Google Scholar 

  9. Meijer RI, Serne EH, Smulders YM et al (2011) Perivascular adipose tissue and its role in type 2 diabetes and cardiovascular disease. Curr Diab Rep 11:211–217. doi:10.1007/s11892-011-0186-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Aquino EML, Barreto SM, Bensenor IM et al (2012) Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol 175:315–324. doi:10.1093/aje/kwr294

    Article  PubMed  Google Scholar 

  11. Schmidt MI, Duncan BB, Mill JG et al (2015) Cohort Profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol 44:68–75. doi:10.1093/ije/dyu027

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lang RM, Bierig M, Devereux RB et al (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108. doi:10.1016/j.euje.2005.12.014

    Article  PubMed  Google Scholar 

  13. 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 17:1086–1119

    PubMed  Google Scholar 

  14. 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  Google Scholar 

  15. 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

    Article  CAS  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. Momesso DP, Bussade I, Epifanio MA et al (2011) Increased epicardial adipose tissue in type 1 diabetes is associated with central obesity and metabolic syndrome. Diabetes Res Clin Pract 91:47–53. doi:10.1016/j.diabres.2010.09.037

    Article  CAS  PubMed  Google Scholar 

  19. 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 88:5163–5168

    Article  CAS  PubMed  Google Scholar 

  20. Ahn S-G, Lim H-S, Joe D-Y et al (2008) Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart 94:e7. doi:10.1136/hrt.2007.118471

    Article  PubMed  Google Scholar 

  21. Rabkin SW (2014) The relationship between epicardial fat and indices of obesity and the metabolic syndrome: a systematic review and meta-analysis. Metab Syndr Relat Disord 12:31–42. doi:10.1089/met.2013.0107

    Article  CAS  PubMed  Google Scholar 

  22. Bertaso AG, Bertol D, Duncan BB, Foppa M (2013) Epicardial fat: definition, measurements and systematic review of main outcomes. Arq Bras Cardiol 101:e18–e28. doi:10.5935/abc.20130138

    PubMed  PubMed Central  Google Scholar 

  23. Alexopoulos N, McLean DS, Janik M et al (2010) Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis 210:150–154

    Article  CAS  PubMed  Google Scholar 

  24. Iacobellis G, Barbaro G, Gerstein HC (2008) Relationship of epicardial fat thickness and fasting glucose. Int J Cardiol 128:424–426. doi:10.1016/j.ijcard.2007.12.072

    Article  PubMed  Google Scholar 

  25. Bettencourt N, Toschke AM, Leite D et al (2012) Epicardial adipose tissue is an independent predictor of coronary atherosclerotic burden. Int J Cardiol 158:26–32. doi:10.1016/j.ijcard.2010.12.085

    Article  CAS  PubMed  Google Scholar 

  26. 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  Google Scholar 

  27. Apfaltrer P, Schindler A, Schoepf UJ et al (2014) Comparison of epicardial fat volume by computed tomography in black versus white patients with acute chest pain. Am J Cardiol 113:422–428. doi:10.1016/j.amjcard.2013.10.014

    Article  PubMed  Google Scholar 

  28. Katzmarzyk PT, Bray GA, Greenway FL et al (2010) Racial differences in abdominal depot-specific adiposity in white and African American adults. Am J Clin Nutr 91:7–15. doi:10.3945/ajcn.2009.28136

    Article  CAS  PubMed  Google Scholar 

  29. Bild DE, Detrano R, Peterson D et al (2005) Ethnic differences in coronary calcification: the multi-ethnic study of atherosclerosis (MESA). Circulation 111:1313–1320. doi:10.1161/01.CIR.0000157730.94423.4B

    Article  PubMed  Google Scholar 

  30. 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

    Article  Google Scholar 

  31. 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

    CAS  Google Scholar 

  32. 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

    Article  Google Scholar 

  33. 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

    Article  PubMed  Google Scholar 

  34. 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

    Article  PubMed  PubMed Central  Google Scholar 

  35. 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 117:605–613

    Article  PubMed  Google Scholar 

  36. 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 88:645–650

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Wong CX, Abed HS, Molaee P et al (2011) Pericardial fat is associated with atrial fibrillation severity and ablation outcome. J Am Coll Cardiol 57:1745–1751. doi:10.1016/j.jacc.2010.11.045

    Article  PubMed  Google Scholar 

  38. Mookadam F, Goel R, Alharthi MS et al (2010) Epicardial fat and its association with cardiovascular risk: a cross-sectional observational study. Heart Views 11:103–108. doi:10.4103/1995-705X.76801

    Article  PubMed  PubMed Central  Google Scholar 

  39. Sicari R, Sironi AM, Petz R et al (2011) Pericardial rather than epicardial fat is a cardiometabolic risk marker: an MRI versus echo study. J Am Soc Echocardiogr 24:1156–1162. doi:10.1016/j.echo.2011.06.013

    Article  PubMed  Google Scholar 

  40. Chung J-H, Kwon B-J, Song S-W et al (2014) Epicardial adipose tissue: relationship between measurement location and metabolic syndrome. Int J Cardiovasc Imaging 30:195–204. doi:10.1007/s10554-013-0308-5

    Article  PubMed  Google Scholar 

  41. 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 20:111–120

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank all ELSA-Brasil participants for their valuable contribution to this study.

Funding

The ELSA-Brasil study was supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology (Financiadora de Estudos e Projetos Grants 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 06 0071.00 RJ), and CNPq National Research Council.

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    Authors and Affiliations

    1. Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

      Daniela Bertol Graeff, Murilo Foppa, Julio Cesar Gall Pires, Alvaro Vigo, Maria Ines Schmidt & Bruce Bartholow Duncan

    2. Postgraduate Studies Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

      Murilo Foppa

    3. University of Sao Paulo, Sao Paulo, Brazil

      Paulo Andrade Lotufo

    4. Federal University of Espirito Santo, Vitoria, Brazil

      Jose Geraldo Mill

    5. School of Medicine, Federal University of Rio Grande do Sul, Av. Ramiro Barcelos, 2600 Sala 414, 90035-003, Porto Alegre, RS, Brazil

      Murilo Foppa

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    1. Daniela Bertol Graeff
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    Correspondence to Murilo Foppa.

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    The authors declare that they have no conflict of interest.

    Ethical approval

    All procedures performed in The ELSA-Brasil were approved by the local ethics committees of the involved institutions in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments.

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    Written informed consent was obtained from all individual participants included in The ELSA-Brasil study.

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    Daniela Bertol Graeff and Murilo Foppa have contributed equally to this manuscript.

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    Graeff, D.B., Foppa, M., Pires, J.C.G. et al. Epicardial fat thickness: distribution and association with diabetes mellitus, hypertension and the metabolic syndrome in the ELSA-Brasil study. Int J Cardiovasc Imaging 32, 563–572 (2016). https://doi.org/10.1007/s10554-015-0810-z

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