Association of Epicardial Adipose Tissue With Cardiometabolic Risk and Metabolic Syndrome in Patients With Rheumatoid Arthritis

Abstract

Objective Patients with rheumatoid arthritis (RA) have increased coronary atherosclerosis possibly related to increased prevalence of visceral adiposity, insulin resistance, and metabolic syndrome. Epicardial adipose tissue (EAT), a type of visceral fat, may contribute to cardiometabolic risk. The aim of this study was to measure EAT volume in patients with RA and determine its relationship with cardiometabolic risk markers and coronary artery calcium. Methods EAT volume and coronary artery calcium score were measured by non-contrast cardiac computed tomography and compared in RA patients (n=162) and controls (N=89). The relationships between EAT volume and markers of cardiometabolic risk in RA were examined with adjustment for age, race and sex. Results Among RA patients, EAT volume was positively associated with IL-6 (P=0.03), triglycerides (P=0.004), hypertension (P=0.01), homeostatic model of insulin resistance (HOMA) (P<0.001), smoking history (P=0.04), and homocysteine (P=0.001) and negatively associated with HDL (P=0.005). With further adjustment for waist circumference (a measure of visceral obesity), EAT remained independently associated with triglycerides, HOMA, current smoking and homocysteine (all P<0.05). EAT volume was not associated with corticosteroid use or coronary artery calcium score. Patients with metabolic syndrome had significantly greater EAT volume (P<0.001) and each increase in metabolic syndrome criteria was associated, on average, with a 20% increase (95% CI, 14–26%) in EAT volume (P<0.001). Conclusion EAT volume is associated with metabolic syndrome and cardiometabolic risk factors including insulin resistance, triglycerides, current smoking, and homocysteine levels, but not with coronary artery calcium in RA patients.

Increased epicardial adipose tissue thickness as a sign of subclinical atherosclerosis in patients with rheumatoid arthritis and ıts relationship with disease activity ındices

“…Again, in a study conducted with systemic sclerosis patients ( n = 30), EATT was demonstrated to be correlated only with disease activity scores ( r = 0.45, p = 0.01) [ 44 ]. Contrary to our results, Petra et al and Ormseth et al did not find any significant correlations between ESR, CRP, DAS28-CRP scores, and EATT values [ 35 , 45 ]. Temiz et al showed significant correlations of EATT with ESR, CRP, and Health Assessment Questionnaire scores, but EATT was not correlated with DAS28 scores [ 31 ].…”

Epicardial Adipose Tissue Volume As a Marker of Subclinical Coronary Atherosclerosis in Rheumatoid Arthritis

“…We further demonstrated that EATV was associated with the presence of mixed plaque in both RA patients and non‐RA controls, yet EATV had no association with advanced and relatively stable calcified plaque in either group. We observed no significant association between EATV and CAC, which is a finding similar to that in the study by Ormseth et al (30). Increasing CAC is related to both higher‐risk mixed plaques and the more stable fully calcified plaques (43).…”

The relationship between epicardial adipose tissue and arterial stiffness in patients with rheumatoid arthritis

“…In agreement with other reports from the general population, we found that in RA patients EAT strongly correlates with age and other markers of obesity, such as BMI and WC [32,33]. Ormseth et al confirmed these anthropomorphic findings in a study performed on 162 RA patients, where EAT was measured by noncontrast cardiac computed tomography (CT) [34]. Similarly, they found no significant associations between EAT and inflammatory markers or DAS-28 CRP score.…”