Epicardial adipose tissue (EAT) volume is related to subclinical atherosclerosis and major adverse cardiovascular events (MACE) in asymptomatic subjects

Introduction Epicardial adipose tissue (EAT) is an emerging cardiovascular risk marker. It has been suggested to be an inflammatory mediator with a role in subclinical atherosclerosis and coronary artery disease. However, its prognostic relevance in hard clinical outcomes remains thoroughly unexplored in the literature. Purpose Evaluate the prognostic relevance of EAT, regarding the occurrence of major adverse cardiovascular events (MACE) in an asymptomatic population. Methods 895 asymptomatic volunteers were prospectively enrolled in a single Portuguese center (mean age 51.9±7.7, 78.5% male) and underwent a median follow-up time of 3.7 years (IQR 5.0). EAT volume was measured by Cardiac Computed Tomography (CCT) using a modified simplified method. Participants were distributed into two groups, above and below the EAT-volume median. We compared both groups regarding the occurrence of MACE through univariate analysis, Kaplan-Meier Survival curves and log-rank test. Association to subclinical atherosclerosis was addressed using correlation between EAT volume and calcium score (Agatson). Results There is a strong correlation between EAT volume and calcium score (r=0.205, p<0.0001), sustaining that it may play an important role in mediating coronary artery disease and subclinical atherosclerosis. Patients with higher EAT volume, were exposed to higher occurrence of MACE on follow-up [70.4% (19 of 27) vs 49.4% (429 of 868), p=0.032] with a clearer separation of the curves after 5.7 years. Conclusion In an asymptomatic population, EAT volume seems to be related to subclinical atherosclerosis and to the occurrence of adverse cardiovascular events on long-term follow-up. Our study addresses some unanswered questions, such as the prognostic relevance of EAT as an emerging cardiovascular risk marker. FUNDunding Acknowledgement Type of funding sources: None.

Metabolic Syndrome, Homocysteine and uric acid in patients with obesity; experience from obesity and work centre

BACKGROUND: Uric acid (UA) and homocysteine (HCys) are involved in cardiovascular diseases. Patients with obesity (PwO) are characterized by elevated cardiovascular risk. OBJECTIVE: To evaluate the relationship between HCys and UA concentrations in 1141 overweight patients and PwO with and without metabolic syndrome (MS). METHODS: MS was defined according to IDF criteria (2005). Anthropometric data were recorded and blood biochemical parameters were assessed with routine methods on fasting blood samples. Statistics: Spearman correlation and multiple regression analysis. RESULTS: Gender, obesity and MS influenced both UA and HCys levels, which were increased in males, MS patients, PwO with MS and positively correlated (p < 0.001). Patients without MS had normal or slightly high levels. Hypertension, hyperuricemia and hyperhomocysteinemia were found in PwO with MS. UA concentration correlated with systolic blood pressure, triglycerides and HDL (all p < 0.05). Multivariate analysis showed that HCys concentration was an independent determinant factor affecting UA levels (T value 3.5, p < 0.001). CONCLUSIONS: HCys and UA levels positively and significantly correlated in PwO, especially in those with MS. The significant correlation between UA and hypertension, triglycerides, HDL suggests the clinical usefulness of monitoring UA together with HCys concentrations as cardiovascular risk marker in these patients.

Neutrophil-to-Lymphocyte Ratio as a Cardiovascular Risk Marker May Be Less Efficient in Women Than in Men

Cardiovascular disease (CVD) is the leading cause of death in women, although traditionally, it has been considered as a male dominated disease. Chronic inflammation plays a crucial role in the development of insulin resistance, diabetes type 2 and CVD. Since studies on women were scarce, in order to improve diagnosis and treatment of CVD, there is a need to improve understanding of the role of inflammation in the development of CVD in women. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and widely available marker of inflammation, and has been studied in cardio-metabolic disorders. There is a paucity of data on sex specific differences in the lifetime course of NLR. Men and women differ to each other in sex hormones and characteristics of immune reaction and the expression of CVD. These factors can determine NLR values and their variations along the life course. In particular, menopause in women is a period associated with profound physiological and hormonal changes, and is coincidental with aging. An emergence of CV risk factors with aging, and age-related changes in the immune system, are factors that are associated with an increase in prevalence of CVD in both sexes. The aim of this review is to comprehend the available evidence on this issue, and to discuss sex specific differences in the lifetime course of NLR in the light of immune and inflammation mechanisms.

Epicardial Adipose Tissue: The Genetics Behind an Emerging Cardiovascular Risk Marker

Evidence points epicardial adipose tissue (EAT) as an emerging cardiovascular risk marker. Whether genetic polymorphisms linked with atherosclerosis are associated with higher EAT is still unknown. We aim to assess the role of genetic burden of atherosclerosis and its association to EAT in a cohort of asymptomatic individuals without coronary disease. A total of 996 participants were prospectively enrolled in a single Portuguese center. EAT volume was measured by Cardiac Computed Tomography and participants were distributed into 2 groups, above and below median EAT. SNPs were genotyped and linked to their respective pathophysiological axes. A multiplicative genetic risk score (mGRS) was constructed, representing the genetic burden of the studied SNPs. To evaluate the association between genetics and EAT, we compared both groups by global mGRS, mGRS by functional axes, and SNPs individually. Individuals above-median EAT were older, had a higher body mass index (BMI) and higher prevalence of hypertension, metabolic syndrome, diabetes, and dyslipidemia. They presented higher GRS, that remained an independent predictor of higher EAT volumes. The group with more EAT consistently presented higher polymorphic burden across numerous pathways. After adjustment, age, BMI, and mGRS of each functional axis emerged as independently related to higher EAT volumes. Amongst the 33 SNPs, MTHFR677 polymorphism emerged as the only significant and independent predictor of higher EAT volumes. Patients with higher polymorphism burden for atherosclerosis present higher EAT volumes. We present the first study in a Portuguese population, evaluating the genetic profile of EAT through GWAS and GRS, casting further insight into this complicated matter.

Quantification of Epicardial Fat Volume as a Novel Cardiovascular Risk Marker in Asymptomatic Subjects for Early Detection of Cardiovascular Disease

Epicardial fat volume (EFV), also known as epicardial adipose tissue (EAT), sometimes acts as a protector against heart problems; however, in excess volume was found to be associated with cardiovascular structural and functional abnormalities. This study aims to establish a threshold between normal and abnormal values for EFV/EAT in asymptomatic subjects, as well as to assess whether excess EFV/EAT is associated with significant structural and functional abnormalities, including coronary artery calcium score (CACS). A total of 220 asymptomatic patients, were screened utilizing Early Cardiovascular Disease Risk Score (ECVDRS), and CT for CACS and EFV/EAT quantification. Out of the 220 subjects, 69 had a 0 CACS and were included in this analysis. These 69 were then further categorized into 3 groups: Group 1 (Normal subjects; n=20) with ECVDRS < 3, and ACC/AHA risk score < 5%; Group 2 (n= 16) with elevated EFV/EAT and no abdominal visceral obesity; Group 3 (n=33) with elevated EFV/EAT and abdominal visceral obesity. The average EFV/EAT was identified to be 69 cm3 ± 20 in females and 68 cm3 ± 15 in males among Group 1, which indicate the normal values for EFV/EAT. It was also found that elevated EFV/EAT without (Group 2) or with (Group 3) abdominal visceral adiposity was associated with significant vascular abnormalities, as compared to the normal group among these populations of asymptomatic patients with 0 CACS. Elevated EFV/EAT is a novel cardiovascular risk marker regardless of gender, which might be the culprit for major cardiovascular risk factors.