Abstract
BackgroundPericardial fat has adverse effects on the surrounding vasculature. Previous studies suggest that pericardial fat may contribute to myocardial ischemia in symptomatic individuals. However, it is unknown if pericardial fat has similar effects in asymptomatic individuals.MethodsWe determined the association between pericardial fat and myocardial blood flow (MBF) in 214 adults with no prior history of cardiovascular disease from the Minnesota field center of the Multi-Ethnic Study of Atherosclerosis (43% female, 56% Caucasian, 44% Hispanic). Pericardial fat volume was measured by computed tomography. MBF was measured by MRI at rest and during adenosine-induced hyperemia. Myocardial perfusion reserve (PR) was calculated as the ratio of hyperemic to resting MBF.ResultsGender-stratified analyses revealed significant differences between men and women including less pericardial fat (71.9±31.3 vs. 105.2±57.5 cm3, p<0.0001) and higher resting MBF (1.12±0.23 vs. 0.93±0.19 ml/min/g, p<0.0001), hyperemic MBF (3.49±0.76 vs. 2.65±0.72 ml/min/g, p<0.0001), and PR (3.19±0.78 vs. 2.93±0.89, p = 0.03) in women. Correlations between pericardial fat and clinical and hemodynamic variables were stronger in women. In women only (p = 0.01 for gender interaction) higher pericardial fat was associated with higher resting MBF (p = 0.008). However, this association was attenuated after accounting for body mass index or rate-pressure product. There were no significant associations between pericardial fat and hyperemic MBF or PR after multivariate adjustment in either gender. In logistic regression analyses there was also no association between impaired coronary vasoreactivity, defined as having a PR <2.5, and pericardial fat in men (OR, 1.18; 95% CI, 0.82–1.70) or women (OR, 1.11; 95% CI, 0.68–1.82).ConclusionsOur data fail to support an independent association between pericardial fat and myocardial perfusion in adults without symptomatic cardiovascular disease. Nevertheless, these findings highlight potentially important differences between asymptomatic and symptomatic individuals with respect to the underlying subclinical disease burden.
Highlights
Visceral adiposity is a well-established risk factor for cardiovascular morbidity and mortality [1]
We previously reported that a number of coronary artery disease (CAD) risk factors, including older age, male gender, elevated blood pressure, and high cholesterol levels, are associated with coronary vascular dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, as evidenced by lower myocardial blood flow (MBF) and/ or myocardial perfusion reserve (PR) [16,17]
The prevalences of diabetes (p = 0.04) and coronary calcium (p = 0.0002) were higher in men compared to women, while more women had abdominal obesity (45% vs. 72% based on a waist circumference .88 cm in women and .102 cm in men, p,0.0001) and reported smoking,100 cigarettes in their lifetime (p = 0.04)
Summary
Visceral adiposity is a well-established risk factor for cardiovascular morbidity and mortality [1]. Pericardial fat around the coronary arteries has been shown to express relatively high levels of interleukin-6, tumor necrosis factor alpha, and monocyte chemoattractant protein-1, but low levels of adiponectin [7,8]. This heightened pro-inflammatory state may promote endothelial dysfunction and vascular remodeling [9,10]. Increased adiponectin levels in the coronary circulation have been associated with a greater coronary vasodilatory response [11] Taken together, these data suggest that pericardial fat may have both direct and indirect effects on vascular structure and function. It is unknown if pericardial fat has similar effects in asymptomatic individuals
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