Abstract
Pericardial fat (PF) a component of visceral adipose tissue has been consistently related to coronary atherosclerosis in the general population. This study evaluated the association between PF and coronary artery calcification (CAC) in non-dialysis dependent chronic kidney disease (CKD) patients. This is a post-hoc cross sectional analysis of the baseline of a prospective cohort of 117 outward CKD patients without manifest coronary artery disease (age, 56.9±11.0 years, 64.1% males, 95.1% hypertensives, 25.2% diabetics, 15.5% ever smokers, CKD stage 2 to 5 with estimated glomerular filtration rate 36.8±18.1 ml/min). CAC scores, PF volume and abdominal visceral fat (AVF) areas were measured by computed tomography. The association of PF as a continuous variable with the presence of CAC was analyzed by multivariate logistic regression. CAC (calcium score >0) was present in 59.2% patients. Those presenting CAC were on average 10 years older, had a higher proportion of male gender (78.7% vs. 42.9%, p<0.001), and had higher values of waist circumference (95.9±10.7 vs. 90.2±13.2 cm, p = 0.02), PF volumes (224.8±107.6 vs. 139.1±85.0 cm3, p<0.01) and AVF areas (109.2±81.5 vs. 70.2±62.9 cm2, p = 0.01). In the multivariate analysis, adjusting for age, gender, diabetes, smoking and, left ventricular concentric hypertrophy, PF was significantly associated with the presence of CAC (OR: 1.88 95% CI: 1.03–3.43 per standard deviation). PF remained associated with CAC even with additional adjustments for estimated glomerular filtration rate or serum phosphorus (OR: 1.85 95% CI: 1.00–3.42, p = 0.05). PF is independently associated with CAC in non-dialysis dependent CKD patients.
Highlights
Chronic kidney disease (CKD) is highly prevalent affecting roughly 7% of the general adult population and up to one in three elder individuals [1]
The aim of this study was to test the association of Pericardial fat (PF) with CAC presence both measured by computed tomography in non-dialysis dependent CKD patients
PF volume correlated with abdominal visceral fat (AVF) area (r50.82, p,0.01), waist circumference (r50.67, p,0.01), BMI (r50.57, p,0.01) and subcutaneous abdominal fat (SAF) area (r50.31, p,0.01)
Summary
Chronic kidney disease (CKD) is highly prevalent affecting roughly 7% of the general adult population and up to one in three elder individuals [1]. Cardiovascular mortality is responsible for 50% of overall deaths and is up to 20 times more incident in CKD individuals than in the general population [3]. Coronary artery calcification (CAC), a marker of subclinical vascular disease that is highly prevalent in CKD, reliably predicts the risk for overall mortality and cardiovascular events in dialytic [4, 5] as well as in non-dialytic patients [6, 7]. Since there is no physical barrier between PF and coronary arteries, PF has been advocated as a paracrine promoter of CAC This hypothesis is supported by studies in non-CKD populations associating PF respectively with CAC presence [11, 12], high-risk coronary atherosclerotic plaque features [13] and incident myocardial infarction [14]. PF has been related with coronary plaque presence even in lean individuals [15], which support the hypothesis that PF could reflect more accurately a riskier adiposity in comparison with other fatness parameters
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