Epicardial adipose tissue is an independent marker of cardiovascular risk in HIV-infected patients

Guaraldi, Giovanni; Scaglioni, Riccardo; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Besutti, Giulia; Bagni, P; Rossi, Rosario; Modena, Maria Grazia; Raggi, Paolo

doi:10.1097/qad.0b013e3283474b9f

Cited by 55 publications

(54 citation statements)

References 34 publications

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“…[32-35] However results were conflicting in patients with HIV. [10, 13] Our study adds to the growing evidence that HIV-infection may affect vascular health. HIV-infection and/or its treatment may cause an alteration in the distribution of visceral adipose tissue including the epicardium.…”

Section: Discussionmentioning

confidence: 81%

“…[12] More recently, Guaraldi and colleagues conducted a larger study and confirmed the presence of greater epicardial fat depots in HIV-infected participants, and also demonstrated an association between epicardial fat and increased coronary artery calcium (CAC). [13] The conflicting conclusions from these initial studies require further study.…”

Section: Introductionmentioning

confidence: 99%

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Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

Brener

Ketlogetswe

Budoff

et al. 2014

Aids

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Objective Cytokines released by epicardial fat are implicated in the pathogenesis of atherosclerosis. HIV infection and anti-retroviral therapy have been associated with changes in body fat distribution and coronary artery disease. We sought to determine if HIV infection is associated with greater epicardial fat and if epicardial fat is associated with subclinical coronary atherosclerosis. Design We studied 579 HIV-infected and 353 HIV-uninfected men age 40 to 70 years with non-contrast computed tomography (CT) to measure epicardial adipose tissue volume (EAT) and coronary artery calcium (CAC). Total plaque score (TPS), and plaque subtypes (non-calcified, calcified and mixed) were measured by coronary CT angiography in 706 men. Methods We evaluated the association between EAT and HIV serostatus, and the association of EAT with subclinical atherosclerosis, adjusting for age, race and serostatus and with additional cardiovascular (CV) risk factors and tested for modifying effects of HIV serostatus. Results HIV-infected men had greater EAT than HIV-uninfected men (p=0.001). EAT was positively associated with duration of antiretroviral therapy (p=0.02), specifically AZT (p<0.05). EAT was associated with presence of any coronary artery plaque (p=0.006) and non-calcified plaque (p=0.001), adjusting for age, race, serostatus and CV risk factors. Among men with CAC, EAT was associated with CAC extent (p=0.006). HIV serostatus did not modify associations between EAT and either CAC extent or presence of plaque. Conclusions Greater epicardial fat volume in HIV-infected men and its association with coronary plaque and antiretroviral therapy duration suggest potential mechanisms that might lead to increased risk for cardiovascular disease in HIV.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

Brener

Ketlogetswe

Budoff

et al. 2014

Aids

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“…EF is inversely associated with ejection fraction and left ventricular mass 33,73 . Additionally, EF may be a manifestation of lipodystrophy associated with subclinical atherosclerosis in patients with HIV, particularly after the introduction of highly active antiretroviral therapy 74 .…”

Section: Clinical Associationsmentioning

confidence: 99%

Epicardial Fat: Definition, Measurements and Systematic Review of Main Outcomes

Bertaso¹,

Bertol²,

Duncan³

et al. 2013

Arquivos Brasileiros De Cardiologia

184

214

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Epicardial fat (EF) is a visceral fat deposit, located between the heart and the pericardium, which shares many of the pathophysiological properties of other visceral fat deposits, It also potentially causes local inflammation and likely has direct effects on coronary atherosclerosis. Echocardiography, computed tomography and magnetic resonance imaging have been used to evaluate EF, but variations between methodologies limit the comparability between these modalities.We performed a systematic review of the literature finding associations of EF with metabolic syndrome and coronary artery disease. The summarization of these associations is limited by the heterogeneity of the methods used and the populations studied, where most of the subjects were at high cardiovascular disease risk.EF is also associated with other known factors, such as obesity, diabetes mellitus, age and hypertension, which makes the interpretation of its role as an independent risk marker intricate. Based on these data, we conclude that EF is a visceral fat deposit with potential implications in coronary artery disease. We describe the reference values of EF for the different imaging modalities, even though these have not yet been validated for clinical use. It is still necessary to better define normal reference values and the risk associated with EF to further evaluate its role in cardiovascular and metabolic risk assessment in relation to other criteria currently used.

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“…Recent data on more than 4,000 patients in the Multi-Ethnic Study of Atherosclerosis (MESA) found increased pericardial fat volume to be associated with higher rates of hard CVD events, stroke and congestive heart failure (CHF), as well as increased left ventricular (LV) mass [27*]. Notably, compared to uninfected patients, HIV-infected patients have increased pericardial fat volumes [28, 29], and within this population increased pericardial fat has been associated with higher coronary artery calcium scores [30–32], increased carotid intima-media thickness [33], and increased myocardial perfusion defects [34] (Table 1). The duration of ART positively correlates with epicardial fat, suggesting the direct effects of ART on adipocytes (as mentioned previously) may play a role in the development of excessive epicardial fat depots [28, 35**].…”

Section: Epicardial and Pericardial Fatmentioning

confidence: 99%

Heart fat in HIV

Buggey¹,

Longenecker

2017

Current Opinion in HIV and AIDS

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Purpose of review To summarize the literature describing the clinical impact of cardiac fat depots in patients with HIV infection. Recent findings People living with HIV (PLHIV) have accelerated rates of cardiovascular disease, and are prone to the development of ectopic fat deposition. Specifically, PLHIV have higher volumes of epicardial and intracardiac fat quantified by non-invasive imaging. Higher volumes of epicardial fat may be related to antiretroviral therapy duration and chronic inflammation, independently of other measures of body adiposity such as body mass index. They have been associated with increased coronary artery calcium, myocardial perfusion defects, death, and myocardial infarction. The association with risk may be partly mediated through direct actions of cytokines and adipokines produced by the adipose tissue. Furthermore, HIV-infected patients have increased myocardial fat deposition that is also associated with antiretroviral therapy duration, and may be responsible for myocardial systolic and diastolic dysfunction. Summary PLHIV have increased fat deposition surrounding and inside the heart that may serve as an important imaging marker of risk but may also directly mediate coronary artery disease and cardiac dysfunction. Although robust data of targeted therapies is lacking, some pharmacotherapies may be able to reduce cardiac fat volumes. In the meantime, as the evidence grows, physicians may consider intensifying preventive strategies and monitoring in patients with abnormal heart fat on non-invasive imaging.

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Epicardial adipose tissue is an independent marker of cardiovascular risk in HIV-infected patients

Abstract: We showed an association between EAT and central fat accumulation and mixed form lipodystrophy phenotypes as well as traditional risk factors for atherosclerosis. EAT may be a useful marker of cardiovascular risk as shown by its association with CAC greater than 100.

Cited by 55 publications

References 34 publications

Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

Epicardial Fat: Definition, Measurements and Systematic Review of Main Outcomes

Heart fat in HIV

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