Epicardial fat and vascular risk: A narrative review

Current Opinion in Cardiology

Volumn 28, Issue 4, 2013, Pages 458-463

  Katsiki, Niki ^a   Mikhailidis, Dimitri P ^b   Wierzbicki, Anthony S ^c  

^a ARISTOTLE UNIVERSITY OF THESSALONIKI   (Greece)

^b ROYAL FREE AND UNIVERSITY COLLEGE MEDICAL SCHOOL   (United Kingdom)

^c ST THOMAS HOSPITAL   (United Kingdom)

Author keywords

cardiovascular disease; drugs; epicardial fat; lifestyle measures; vascular risk factors

Indexed keywords

ADIPONECTIN; ATORVASTATIN; CHEMERIN; EZETIMIBE; GAMMA GLUTAMYLTRANSFERASE; LEPTIN; MONOCYTE CHEMOTACTIC PROTEIN 1; NICOTINAMIDE PHOSPHORIBOSYLTRANSFERASE; PIOGLITAZONE; SIMVASTATIN; TUMOR NECROSIS FACTOR ALPHA; VASPIN;

ADIPOCYTE; ATHEROSCLEROSIS; BODY FAT; CARDIOVASCULAR RISK; CORONARY ARTERY DISEASE; DISEASE ASSOCIATION; EPICARDIAL FAT; HUMAN; HYPERTENSION; INFLAMMATION; INSULIN RESISTANCE; LIFESTYLE; LIPID METABOLISM; METABOLIC SYNDROME X; NON INSULIN DEPENDENT DIABETES MELLITUS; OBESITY; OXIDATIVE STRESS; PERCUTANEOUS CORONARY INTERVENTION; PRIORITY JOURNAL; REVIEW; SLEEP DISORDERED BREATHING; WEIGHT REDUCTION;

ADIPOSITY; ANIMALS; ATHEROSCLEROSIS; CARDIOVASCULAR AGENTS; CORONARY ARTERY DISEASE; HUMANS; RISK FACTORS; RISK REDUCTION BEHAVIOR;

EID: 84879952824     PISSN: 02684705     EISSN: 15317080     Source Type: Journal    
DOI: 10.1097/HCO.0b013e3283605fba     Document Type: Review

References (90)

1. Wronska A, Kmiec Z. Structural and biochemical characteristics of various white adipose tissue depots. Acta Physiol (Oxf) 2012; 205:194-208.
2. Sacks HS, Fain JN. Human epicardial fat: what is new and what is missing? Clin Exp Pharmacol Physiol 2011; 38:879-887.
3. Guzzardi MA, Iozzo P. Fatty heart, cardiac damage, and inflammation. Rev Diabet Stud 2011; 8:403-417.
4. Lin YK, Chen YJ, Chen SA. Potential atrial arrhythmogenicity of adipocytes: implications for the genesis of atrial fibrillation. Med Hypotheses 2010; 74:1026-1029.
5. Iozzo P. Myocardial, perivascular, and epicardial fat. Diabetes Care 2011; 34 (Suppl 2):S371-S379.
6. Cherian S, Lopaschuk GD, Carvalho E. Cellularcross-talkbetween epicardial adipose tissue and myocardium in relation to the pathogenesis of cardiovas-cular disease. Am J Physiol Endocrinol Metab 2012; 303:E937-E949.
7. Baig A, Campbell B, Russell M, et al. Epicardial fat necrosis: an uncommon etiology of chest pain. Cardiol J 2012; 19:424-428.
8. Iacobellis G, Malavazos AE, Corsi MM. Epicardial fat: from the biomolecular aspects to the clinical practice. Int J Biochem Cell Biol 2011; 43:1651-1654.
9. Bays HE, González-Campoy JM, Henry RR, et al., Adiposopathy Working Group. Isadiposopathy (sickfat) an endocrinedisease? Int J Clin Pract 2008; 62:1474-1483.
10. Sacks HS, Fain JN, Cheema P, et al. Depot-specific overexpression of proinflammatory, redox, endothelial cell, and angiogenic genes in epicardial fat adjacent to severe stable coronary atherosclerosis. Metab Syndr Relat Disord 2011; 9:433-439.
11. Payne GA, Kohr MC, Tune JD. Epicardial perivascular adipose tissue as a therapeutic target in obesity-related coronary artery disease. Br J Pharmacol 2012; 165:659-669.
12. Kremen J, Dolinkova M, Krajickova J, et al. Increased subcutaneous and epicardial adipose tissue production of proinflammatory cytokines in cardiac surgery patients: possible role in postoperative insulin resistance. J Clin Endocrinol Metab 2006; 91:4620-4627.
13. Gormez S, Demirkan A, Atalar F, et al. Adipose tissue gene expression of adiponectin, tumor necrosis factor-α and leptin in metabolic syndrome patients with coronary artery disease. Intern Med 2011; 50:805-810.
14. Payne GA, Borbouse L, Kumar S, et al. Epicardial perivascular adipose-derived leptin exacerbates coronary endothelial dysfunction in metabolic syndrome via a protein kinase C-beta pathway. Arterioscler Thromb Vasc Biol 2010; 30:1711-1717.
15. Spiroglou SG, Kostopoulos CG, Varakis JN, Papadaki HH. Adipokines in periaortic and epicardial adipose tissue: differential expression and relation to atherosclerosis. J Atheroscler Thromb 2010; 17:115-130.
16. Teijeira-Fernandez E, Eiras S, Shamagian LG, et al. Lower epicardial adipose tissue adiponectin in patients with metabolic syndrome. Cytokine 2011; 54:185-190.
17. Teijeira-Fernandez E, Eiras S, Grigorian-Shamagian L, et al. Epicardial adipose tissue expression of adiponectin is lower in patients with hyperten-sion. J Hum Hypertens 2008; 22:856-863.
18. Karayannis G, Giamouzis G, Tziolas N, et al. Association between epicardial fat thickness and weight homeostasis hormones in patients with noncachectic heart failure. Angiology 2013; 64:173-180.
19. Baker AR, Silva NF, Quinn DW, et al. Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovas-cular disease. Cardiovasc Diabetol 2006; 5:1.
20. Shaker O, El-Shehaby A, Zakaria A, et al. Plasma visfatin and retinol binding protein-4 levels in patients with type 2 diabetes mellitus and their relationship to adiposity and fatty liver. Clin Biochem 2011; 44:1457-1463.
21. Salgado-Somoza A, Teijeira-Fernández E, Rubio J, et al. Coronary artery disease is associated with higher epicardial retinol-binding protein 4 (RBP4) and lower glucose transporter (GLUT) 4 levels in epicardial and subcutaneous adipose tissue. Clin Endocrinol (Oxf) 2012; 76:51-58.
22. Salgado-Somoza A, Teijeira-Fernández E, Fernández AL, et al. Proteomic analysis of epicardial and subcutaneous adipose tissue reveals differences in proteins involved in oxidative stress. Am J Physiol Heart Circ Physiol 2010; 299:H202-H209.
23. Eiras S, Teijeira-Fernández E, Salgado-Somoza A, et al. Relationship between epicardial adipose tissue adipocyte size and MCP-1 expression. Cytokine 2010; 51:207-212.
24. Bambace C, Telesca M, Zoico E, et al. Adiponectin gene expression and adipocyte diameter: a comparison between epicardial and subcutaneous adipose tissue in men. Cardiovasc Pathol 2011; 20:e153-e156.
25. Manco M, Morandi A, Marigliano M, et al. Epicardial fat, abdominal adiposity and insulin resistance in obese prepubertal and early pubertal children. Atherosclerosis 2013; 226:490-495.
26. Teijeira-Fernandez E, Eiras S, Grigorian-Shamagian L, et al. Diabetic and nondiabetic patients express similar adipose tissue adiponectin and leptin levels. Int J Obes (Lond) 2010; 34:1200-1208.
27. Hirata Y, Kurobe H, Akaike M, et al. Enhanced inflammation in epicardial fat in patients with coronary artery disease. Int Heart J 2011; 52:139-142.
28. Park JS, Choi SY, Zheng M, et al. Epicardial adipose tissue thickness is a predictor for plaque vulnerability in patients with significant coronary artery disease. Atherosclerosis 2013; 226:134-139.
29. Ito T, Nasu K, Terashima M, et al. The impact of epicardial fat volume on coronary plaque vulnerability: insight from optical coherence tomography analysis. Eur Heart J Cardiovasc Imaging 2012; 13:408-415.
30. Mazzoccoli G, Copetti M, Dagostino MP, et al. Epicardial adipose tissue and idiopathic deep venous thrombosis: an association study. Atherosclerosis 2012; 223:378-383.
31. Cikim AS, Topal E, Harputluoglu M, et al. Epicardial adipose tissue, hepatic steatosis and obesity. J Endocrinol Invest 2007; 30:459-464.
32. Lubrano C, Saponara M, Barbaro G, et al. Relationships between body fat distribution, epicardial fat and obstructive sleep apnea in obese patients with and without metabolic syndrome. PLo S One 2012; 7:e47059.
33. Mariani S, Fiore D, Barbaro G, et al. Association of epicardial fat thickness with the severity of obstructive sleep apnea in obese patients. Int J Cardiol 2012. [Epub ahead of print]
34. Yazici D, Ozben B, Yavuz D, et al. Epicardial adiposetissuethickness intype 1 diabetic patients. Endocrine 2011; 40:250-255.
35. Wang CP, Hsu HL, Hung WC, et al. Increased epicardial adipose tissue (EAT) volume intype 2diabetes mellitus and association with metabolic syndrome and severityof coronaryatherosclerosis.Clin Endocrinol (Oxf) 2009; 70:876-882.
36. Momesso DP, Bussade I, Epifanio MA, et al. Increased epicardial adipose tissue in type 1 diabetes is associated with central obesity and metabolic syndrome. Diabetes Res Clin Pract 2011; 91:47-53.
37. Greulich S, Maxhera B, Vandenplas G, et al. Secretory products from epicardial adipose tissue of patients with type 2 diabetes mellitus induce cardiomyocyte dysfunction. Circulation 2012; 126:2324-2334.
38. Wang TD, Chen MF. Thicker epicardial adipose tissue in nonobese hyper-tensive patients: an innocent bystanderoroverlooked villain? Am J Hypertens 2011; 24:1191-1192.
39. Sengul C, Cevik C, Ozveren O, et al. Epicardial fat thickness is associated with nondipper blood pressure pattern in patients with essential hypertension. Clin Exp Hypertens 2012; 34:165-170.
40. Ertas F, Kaya H, Acet H, et al. Increased echocardiographic epicardial fat thickness is related to impaired diurnal blood pressure profiles. Blood Press 2012; 21:202-208.
41. Sengul C, Ozveren O, Duman D, et al. Echocardiographic epicardial fat thickness is related to altered blood pressure responses to exercise stress testing. Blood Press 2011; 20:303-308.
42. Pierdomenico SD, Pierdomenico AM, Neri M, Cuccurullo F. Epicardial adipose tissue and metabolic syndrome in hypertensive patients with normal body weight and waist circumference. Am J Hypertens 2011; 24:1245-1249.
43. Sengul C, Cevik C, Ozveren O, et al. Echocardiographic epicardial fat thickness is associated with carotid intima-media thickness in patients with metabolic syndrome. Echocardiography 2011; 28:853-858.
44. Lioudaki E, Florentin M, Ganotakis ES, Mikhailidis DP. Microalbuminuria: a neglected cardiovascular riskfactor in nondiabetic individuals? Curr Pharm Des 2013; 164:141-150.
45. Gluba A, Mikhailidis DP, Lip GY, et al. Metabolic syndromeand renal disease. Int J Cardiol 2012. [Epub ahead of print]
46. Katsiki N, Papanas N, Fonseca VA, et al. Uric acid and diabetes: is there a link? Curr Pharm Des 2012. [Epub ahead of print]
47. Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. Endothelial dysfunc-tion in metabolic syndrome: prevalence, pathogenesis and management. Nutr Metab Cardiovasc Dis 2010; 20:140-146.
48. Aydogdu A, Uckaya G, Tasci I, et al. The relationship of epicardial adipose tissue thickness to clinical and biochemical features in women with polycystic ovary syndrome. Endocr J 2012; 59:509-516.
49. Cakir E, Dogan M, Topaloglu O, et al. Subclinical atherosclerosis and hyperandrogenemia are independent risk factors for increased epicardial fat thickness in patients with PCOS and idiopathic hirsutism. Atherosclerosis 2013; 226:291-295.
50. Mc Gowan MP. Polycystic ovary syndrome: a common endocrine disorder and risk factor for vascular disease. Curr Treat Options Cardiovasc Med 2011; 13:289-301.
51. Katsiki N, Athyros VG, Karagiannis A, Mikhailidis DP. Hyperuricaemia and nonalcoholic fatty liver disease (NAFLD): a relationship with implications for vascular risk? Curr Vasc Pharmacol 2011; 9:698-705.
52. Yilmaz Y, Kurt R, Gurdal A, et al. Circulating vaspin levels and epicardial adipose tissue thickness are associated with impaired coronary flow reserve in patients with nonalcoholic fatty liver disease. Atherosclerosis 2011; 217:125-129.
53. Whayne TF Jr. Epicardial fat thickness in heart failure and other clinical conditions. Angiology 2013; 64:169-172.
54. Karadag B, Ozulu B, Ozturk FY, et al. Comparison of epicardial adiposetissue (EAT) thickness and anthropometric measurements in metabolic syndrome (MS) cases above and under the age of 65. Arch Gerontol Geriatr 2011; 52:e79-e84.
55. de Vos AM, Prokop M, Roos CJ, et al. Peri-coronary epicardial adiposetissue is related to cardiovascular risk factors and coronary artery calcification in postmenopausal women. Eur Heart J 2008; 29: 777-783.
56. Kolovou GD, Mikhailidis DP, Kovar J, et al. Assessment and clinical relevance of nonfasting and postprandial triglycerides: an expert panel statement. Curr Vasc Pharmacol 2011; 9:258-270.
57. Wang TD, Lee WJ, Shih FY, et al. Relations of epicardial adipose tissue measured by multidetector computed tomography to components of the metabolic syndrome are region-specific and independent of anthropometric indexes and intraabdominal visceral fat J Clin Endocrinol Metab 2009; 94:662-669.
58. Colak Y, Karabay CY, Tuncer I, et al. Relation of epicardial adiposetissue and carotid intima-mediathickness in patientswith nonalcoholicfattyliverdisease. Eur J Gastroenterol Hepatol 2012; 24:613-618.
59. Ege MR, Guray U, Guray Y, et al. Serum7-glutamyltransferase levelscorrelate with epicardial adipose tissue thickness in patients with coronary artery disease. Angiology 2013; 64:21-25.
60. Ghouri N, Preiss D, Sattar N. Liver enzymes, nonalcoholic fatty liver disease, and incident cardiovascular disease: a narrative review and clinical perspec-tive of prospective data. Hepatology 2010; 52:1156-1161.
61. Fraser A, Harris R, Sattar N, et al. Gamma-glutamyltransferase is associated with incident vascular events independently of alcohol intake: analysis of the British Women's Heart and Health Study and Meta-Analysis. Arterioscler Thromb Vasc Biol 2007; 27:2729-2735.
62. Turan MN, Gungor O, Asci G, et al. Epicardial adipose tissue volume and cardiovascular disease in hemodialysis patients. Atherosclerosis 2013; 226:129-133.
63. Lai YH, Yun CH, Yang FS, et al. Epicardial adipose tissue relating to anthropometrics, metabolic derangements and fatty liver disease indepen-dentlycontributestoserum high-sensitivityC-reactive protein beyond bodyfat composition: a study validated with computed tomography. J Am Soc Echo-cardiogr 2012; 25:234-241.
64. Park HE, Choi SY, Kim HS, et al. Epicardial fat reflects arterial stiffness: assessment using 256-slice multidetector coronary computed tomography and cardio-ankle vascular index. J Atheroscler Thromb 2012; 19:570-576.
65. Kim BJ, Kim BS, Kang JH. Echocardiographic epicardial fat thickness is associated with arterial stiffness. Int J Cardiol 2012. [Epub ahead of print]
66. Natale F, Tedesco MA, Mocerino R, et al. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hyper-tensives. Eur J Echocardiogr 2009; 10:549-555.
67. Błachnio-Zabielska AU, Baranowski M, Hirnle T, et al. Increased bioactive lipidscontent in human subcutaneousand epicardialfattissue correlateswith insulin resistance. Lipids 2012; 47:1131-1141.
68. Kim HM, Kim KJ, Lee HJ, et al. Epicardial adipose tissue thickness is an indicatorforcoronaryarterystenosisin asymptomatictype2diabetic patients: its assessment by cardiac magnetic resonance. Cardiovasc Diabetol 2012; 11:83.
69. Nabati M, Saffar N, Yazdani J, Parsaee MS. Relationship between epicardial fat measured by echocardiography and coronary atherosclerosis: a single-blind historical cohort study. Echocardiography 2013. doi: 10.1111/echo.12083. [Epub ahead of print]
70. Toth PP. Epicardial steatosis, insulin resistance, and coronary artery disease. Heart Fail Clin 2012; 8:671-678.
71. Xu Y, Cheng X, Hong K, et al. Howto interpret epicardial adipose tissue as a cause of coronary artery disease: a meta-analysis. Coron Artery Dis 2012; 23:227-233.
72. Bachar GN, Dicker D, Kornowski R, Atar E. Epicardial adipose tissue as a predictor of coronary artery disease in asymptomatic subjects. Am J Cardiol 2012; 110:534-538.
73. Doesch C, Haghi D, FlüchterS, et al. Epicardialadiposetissue in patientswith heartfailure. J Cardiovasc Magn Reson 2010; 12:40.
74. Comert N, Yucel O, Ege MR, et al. Echocardiographic epicardial adipose tissue predicts subclinical atherosclerosis: epicardial adipose tissue and atherosclerosis. Angiology 2012; 63:586-590.
75. Pracon R, Kruk M, Kepka C, et al. Epicardial adipose tissue radiodensity is independently related to coronary atherosclerosis. A multidetector computed tomography study. Circ J 2011; 75:391-397.
76. Huang G, Wang D, Zeb I, et al. Intra-thoracicfat, cardiometabolic riskfactors, and subclinical cardiovascular disease in healthy, recently menopausal wo-men screened for the Kronos Early Estrogen Prevention Study (KEEPS). Atherosclerosis 2012; 221:198-205.
77. Yerramasu A, Dey D, Venuraju S, et al. Increased volumeof epicardialfat isan independent risk factor for accelerated progression of sub-clinical coronary atherosclerosis. Atherosclerosis 2012; 220:223-230.
78. Kerr JD, Holden RM, Morton AR, et al. Associations of epicardial fat with coronary calcification, insulin resistance, inflammation, and fibroblast growth factor-23 in stage 3-5 chronic kidney disease. BMC Nephrol 2013; 14:26.
79. Turkmen K, Ozbek O, Kayikcioglu H, et al. The relationship between epicardial adipose tissue and coronary artery calcification in peritoneal dialysis patients. Cardiorenal Med 2012; 2:43-51.
80. Otaki Y, Rajani R, Cheng VY, et al. The relationship between epicardial fat volume and incident coronary artery calcium. J Cardiovasc Comput Tomogr 2011; 5:310-316.
81. Orchard TJ, Temprosa M, Barrett-Connor E, et al., Diabetes Prevention Program Outcomes Study Research Group. Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study. Diabet Med 2013; 30:46-55.
82. Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.
83. Kim MK, Tanaka K, Kim MJ, et al. Comparison of epicardial, abdominal and regionalfatcompartments in responsetoweight loss. Nutr Metab Cardiovasc Dis 2009; 19:760-766.
84. Iacobellis G, Singh N, Wharton S, Sharma AM. Substantial changes in epicardial fat thickness after weight loss in severely obese subjects. Obesity (Silver Spring) 2008; 16:1693-1697.
85. Gaborit B, Jacquier A, Kober F, et al. Effects of bariatric surgery on cardiac ectopicfat: lesserdecrease in epicardial fat compared tovisceral fat loss and no change in myocardial triglyceride content. J Am Coll Cardiol 2012; 60:1381-1389.
86. Wilund KR, Tomayko EJ, Wu PT, et al. Intradialytic exercise training reduces oxidativestressand epicardialfat: apilotstudy. Nephrol Dial Transplant 2010; 25:2695-2701.
87. Kim MK, Tomita T, Kim MJ, et al. Aerobic exercise training reduces epicardial fat in obese men. J Appl Physiol 2009; 106:5-11.
88. Sacks HS, Fain JN, Cheema P, et al. Inflammatory genes in epicardial fat contiguous with coronary atherosclerosis in the metabolic syndrome and type 2 diabetes: changes associated with pioglitazone. Diabetes Care 2011; 34:730-733.
89. Girman CJ, Rhodes T, Mercuri M, et al., 4S Group, the AFCAPS/Tex CAPS Research Group. The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/Tex CAPS). Am J Car-diol 2004; 93:136-141.
90. Park JH, Park YS, Kim YJ, et al. Effectsofstatinsontheepicardialfatthickness in patients with coronary artery stenosis underwent percutaneous coronary intervention: comparison of atorvastatin with simvastatin/ezetimibe. J Cardio-vasc Ultrasound 2010; 18:121-126.