The Role of Perivascular Adipose Tissue in Microvascular Function and Coronary Atherosclerosis

Abstract

Microvascular function is an independent risk factor for cardiovascular events, but the causes of microvascular dysfunction remain poorly understood. The role of perivascular adipose tissue (PVAT) in the regulation of vascular function is now a well-established concept supported by ample evidence from animal and translational studies. Importantly, contrary to the traditional notion of PVAT as the cause of vascular dysfunction, recent translational studies have demonstrated that there is a bidirectional communication between the vascular wall and PVAT, the latter playing a key role in diverse aspects of microvascular function and vascular disease, from endothelial dysfunction and microvascular angina to atherosclerosis development and plaque rupture. Although the associations between visceral or subcutaneous adipose tissue with cardiovascular disease risk have been largely explored in clinical studies, the role of PVAT in human atherosclerosis has remained elusive, mainly because of the lack of appropriate tools to study it. However, thanks to recent advances in the field of cardiovascular imaging, noninvasive phenotyping of human coronary PVAT is now feasible. Coronary computed tomography angiography and the use of perivascular Fat Attenuation Index has emerged as a valuable noninvasive biomarker to characterize PVAT and to risk stratify patients for cardiovascular disease risk. In this review we provide an overview of the role of PVAT in microvascular function, the findings of the recent clinical studies in the field, and the role of PVAT as a biomarker in cardiovascular disease.