Correlation between Obesity and Epicardial Fat Volume in Patients With Coronary Artery Disease: From the Alternative Cardiovascular Bio-Imaging Markers Registry
https://doi.org/10.18087/cardio.2025.1.n2782
Abstract
Background. The primary objective was to investigate the relationship between and obesity and epicardial fat volume (EFV) in individuals diagnosed with coronary artery disease (CAD), with the aim of determining whether a consistent linear relationship exists among these factors.
Material and methods. This cross-sectional study involved a total of 510 participants. To explore the relationship between EFV and obesity in CAD patients, we controlled for potential confounding variables, including age, sex, diabetes mellitus, smoking history, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, statin use, vasculopathy, and prior acute myocardial infarction.
Results. After adjusting for confounding factors, a non-linear relationship was observed between obesity and EFV, with an inflection point identified at 200 ml. The effect sizes and their respective confidence intervals were 1.02 (CI: 1.02-1.03) and 0.99 (CI: 0.98-1.00) on either side of this inflection point. Below a EFV of 200 ml, a positive correlation between obesity and EFV was apparent.
Conclusion. The relationship between obesity and EFV in CAD patients is non-linear, and this should be considered when developing prognostic models for CAD. The findings suggest that the relationship between EFV and obesity is more complex than previously thought and warrants further investigation to better understand its implications for both CAD and obesity risk assessment and management.
Supporting agencies: No conflict of interest is reported.
About the Authors
Can Xu
Nanjing Drum Tower Hospital, Department of Cardiac Surgery, the Affiliated Hospital of Nanjing University Medical School
China
China
MD, PhD
Jiangsu, China
Dongjing Wang
Nanjing Drum Tower Hospital, Department of Cardiac Surgery, the Affiliated Hospital of Nanjing University Medical School
China
China
MD, PhD
Jiangsu, China
References
1. Monti CB, Codari M, De Cecco CN, Secchi F, Sardanelli F, Stillman AE. Novel imaging biomarkers: epicardial adipose tissue evaluation. The British Journal of Radiology. 2020;93(1113):20190770. DOI: 10.1259/bjr.20190770
2. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nature Clinical Practice Cardiovascular Medicine. 2005;2(10):536–43. DOI: 10.1038/ncpcardio0319
3. Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H et al. Human Epicardial Adipose Tissue Is a Source of Inflammatory Mediators. Circulation. 2003;108(20):2460–6. DOI: 10.1161/01.CIR.0000099542.57313.C5
4. Barrett-Connor EL. Obesity, Atherosclerosis, and Coronary Artery Disease. Annals of Internal Medicine. 1985;103(6 Pt 2):1010–9. DOI: 10.7326/0003-4819-103-6-1010
5. Jahangir E, De Schutter A, Lavie CJ. The relationship between obesity and coronary artery disease. Translational Research. 2014;164(4):336–44. DOI: 10.1016/j.trsl.2014.03.010
6. Karampetsou N, Alexopoulos L, Minia A, Pliaka V, Tsolakos N, Kontzoglou K et al. Epicardial Adipose Tissue as an Independent Cardiometabolic Risk Factor for Coronary Artery Disease. Cureus. 2022;14(6):e25578. DOI: 10.7759/cureus.25578
7. Khurana R, Yadav A, Buxi TBS, Sawhney JPS, Rawat KS, Ghuman SS. Correlation of epicardial fat quantification with severity of coronary artery disease: A study in Indian population. Indian Heart Journal. 2018;70(Suppl 3):S140–5. DOI: 10.1016/j.ihj.2018.08.009
8. Nagayama Y, Nakamura N, Itatani R, Oda S, Kusunoki S, Takahashi H et al. Epicardial fat volume measured on nongated chest CT is a predictor of coronary artery disease. European Radiology. 2019;29(7):3638–46. DOI: 10.1007/s00330-019-06079-x
9. Sun Y, Li X, Xu K, Hou J, You H, Zhang R et al. Relationship between epicardial fat volume on cardiac CT and atherosclerosis severity in three-vessel coronary artery disease: a single-center cross-sectional study. BMC Cardiovascular Disorders. 2022;22(1):76. DOI: 10.1186/s12872-022-02527-7
10. Villasante Fricke AC, Iacobellis G. Epicardial Adipose Tissue: Clinical Biomarker of Cardio-Metabolic Risk. International Journal of Molecular Sciences. 2019;20(23):5989. DOI: 10.3390/ijms20235989
11. Neeland IJ, Ross R, Després J-P, Matsuzawa Y, Yamashita S, Shai I et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. The Lancet Diabetes & Endocrinology. 2019;7(9):715–25. DOI: 10.1016/S2213-8587(19)30084-1
12. Iacobellis G. Epicardial adipose tissue in contemporary cardiology. Nature Reviews Cardiology. 2022;19(9):593–606. DOI: 10.1038/s41569-022-00679-9
13. Iacobellis G. Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nature Reviews Endocrinology. 2015;11(6):363–71. DOI: 10.1038/nrendo.2015.58
14. Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Di Mario U et al. Epicardial Fat from Echocardiography: A New Method for Visceral Adipose Tissue Prediction. Obesity Research. 2003;11(2):304–10. DOI: 10.1038/oby.2003.45
15. Alexopoulos N, Melek BH, Arepalli CD, Hartlage G-R, Chen Z, Kim S et al. Effect of Intensive Versus Moderate Lipid-Lowering Therapy on Epicardial Adipose Tissue in Hyperlipidemic Post- Menopausal Women: a substudy of the BELLES trial (Beyond Endorsed Lipid Lowering with EBT Scanning). Journal of the American College of Cardiology. 2013;61(19):1956–61. DOI: 10.1016/j.jacc.2012.12.051
16. Milanese G, Silva M, Ledda RE, Goldoni M, Nayak S, Bruno L et al. Validity of epicardial fat volume as biomarker of coronary artery disease in symptomatic individuals: Results from the ALTER-BIO registry. International Journal of Cardiology. 2020;314:20–4. DOI: 10.1016/j.ijcard.2020.04.031
17. Milanese G, Silva M, Bruno L, Goldoni M, Benedetti G, Rossi E et al. Quantification of epicardial fat with cardiac CT angiography and association with cardiovascular risk factors in symptomatic patients: from the ALTER-BIO (Alternative Cardiovascular Bio-Imaging markers) registry. Diagnostic and Interventional Radiology. 2019;25(1):35–41. DOI: 10.5152/dir.2018.18037
18. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102-38. DOI: 10.1161/01.cir.0000437739.71477.ee
19. Austen W, Edwards J, Frye R, Gensini G, Gott V, Griffith L et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation. 1975;51(4 Suppl):5–40. DOI: 10.1161/01.CIR.51.4.5
20. Phelan EA, Borson S, Grothaus L, Balch S, Larson EB. Association of Incident Dementia With Hospitalizations. JAMA. 2012;307(2):165–72. DOI: 10.1001/jama.2011.1964
21. Chandra J, Armengol De La Hoz MA, Lee G, Lee A, Thoral P, Elbers P et al. A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation. Critical Care. 2022;26(1):103. DOI: 10.1186/s13054-022-03968-4
22. Aitken-Buck HM, Moharram M, Babakr AA, Reijers R, Van Hout I, Fomison-Nurse IC et al. Relationship between epicardial adipose tissue thickness and epicardial adipocyte size with increasing body mass index. Adipocyte. 2019;8(1):412–20. DOI: 10.1080/21623945.2019.1701387
23. Rabkin SW. The Relationship Between Epicardial Fat and Indices of Obesity and the Metabolic Syndrome: A Systematic Review and Meta-Analysis. Metabolic Syndrome and Related Disorders. 2014;12(1):31–42. DOI: 10.1089/met.2013.0107
24. Pierdomenico SD, Pierdomenico AM, Cuccurullo F, Iacobellis G. Meta-Analysis of the Relation of Echocardiographic Epicardial Adipose Tissue Thickness and the Metabolic Syndrome. The American Journal of Cardiology. 2013;111(1):73–8. DOI: 10.1016/j.amjcard.2012.08.044
25. Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappaterreno A et al. Echocardiographic Epicardial Adipose Tissue Is Related to Anthropometric and Clinical Parameters of Metabolic Syndrome: A New Indicator of Cardiovascular Risk. The Journal of Clinical Endocrinology & Metabolism. 2003;88(11):5163–8. DOI: 10.1210/jc.2003-030698
26. Iacobellis G, Gra‐Menendez S. Effects of Dapagliflozin on Epicardial Fat Thickness in Patients with Type 2 Diabetes and Obesity. Obesity (Silver Spring). 2020;28(6):1068–74. DOI: 10.1002/oby.22798
27. Ngo DT, Gokce N. Epicardial Adipose Tissue: A Benign Consequence of Obesity? Circulation: Cardiovascular Imaging. 2015;8(3):e003156. DOI: 10.1161/CIRCIMAGING.115.003156
28. Gruzdeva O, Uchasova E, Dyleva Y, Borodkina D, Akbasheva O, Belik E et al. Relationships between epicardial adipose tissue thickness and adipo-fibrokine indicator profiles post-myocardial infarction. Cardiovascular Diabetology. 2018;17(1):40. DOI: 10.1186/s12933-018-0679-y
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For citations:
Xu C., Wang D. Correlation between Obesity and Epicardial Fat Volume in Patients With Coronary Artery Disease: From the Alternative Cardiovascular Bio-Imaging Markers Registry. Kardiologiia. 2025;65(1):34-40. https://doi.org/10.18087/cardio.2025.1.n2782
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