Regional coronary endothelial dysfunction is related to the degree of local epicardial fat in people with HIV

Soleimanifard, Sahar; Schär, Michael; Brown, Todd T.; Bonanno, Gabriele; Barditch‐Crovo, Patricia; Mathews, Lena; Lai, Shenghan; Gerstenblith, Gary; Weiss, Robert G.; Hays, Allison G.

doi:10.1016/j.atherosclerosis.2018.08.002

Cited by 21 publications

(16 citation statements)

References 44 publications

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“…Prior literature demonstrated that measures of EAT among a non-HFpEF sample were similar with those among controls our study: 3.8 mm for RV EAT and 14.4-16.3 mm for AV groove EAT. 14,[22][23][24] Additionally, measures of abdominal subcutaneous and visceral fat, as well as thigh subcutaneous and intra/intermuscular fat, in our control sample were comparable with those reported in prior literature. 8,25,26 Further research is needed to assess whether these findings contribute to the increased morbidity, cardiovascular events, and hospitalizations experienced by HFpEF patients.…”

Section: Regional Adipose Tissue Distributionsupporting

confidence: 87%

Visceral adiposity, muscle composition, and exercise tolerance in heart failure with preserved ejection fraction

et al. 2021

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Aims Visceral adipose tissue (AT) promotes inflammation and may be associated with disease progression in heart failure with preserved ejection fraction (HFpEF). We characterized regional AT distribution in HFpEF patients and controls and analysed associations with co-morbidities and exercise tolerance. Methods and results Magnetic resonance imaging was performed to quantify epicardial, liver, abdominal, and thigh skeletal muscle AT. We assessed New York Heart Association (NYHA) class, 6 min walk distance, and global well-being score. Multivariable linear regression models adjusting for body surface area were used. We studied 55 HFpEF patients (41 women, mean age 67 ± 11 years) and 33 controls (21 women, mean age 57 ± 10 years). Epicardial AT (median [interquartile range] 4.6 [2.0] vs. 3.2 [1.4] mm, P < 0.001), thigh intermuscular fat (11.0 [11.5] vs. 5.0 [2.7] cm 2 , P < 0.001) and liver fat fraction (6.4% [6.1] vs. 4.1% [5.5], P = 0.001) were higher in HFpEF patients than controls. Women with HFpEF had higher abdominal and thigh subcutaneous AT than men. Greater thigh intermuscular fat was associated with higher blood pressure (β [SE] 0.73 [0.17], P < 0.001) and diabetes (odds ratio [95% confidence interval] 1.2 [1.0-1.5], P = 0.03). Greater thigh intramuscular fat was associated with both worse NYHA class (β [SE] 2.7 [1.0], P = 0.01) and shorter 6 min walk distance (β [SE] À4.1 [1.9], P = 0.03), and greater epicardial AT (β [SE] À0.2 [0.1], P < 0.001) and liver fat fraction (β [SE] À0.4 [0.2], P = 0.04) were associated with lower global well-being score. Conclusions Heart failure with preserved ejection fraction patients have increased epicardial, liver, and skeletal muscle fat compared with controls out of proportion to their increased body size, and adiposity was associated with worse NYHA class and exercise tolerance in HFpEF. These results provide the basis for further investigation into the effect of interventions to reduce regional AT distribution in relation to HFpEF symptoms and pathophysiology.

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Section: Regional Adipose Tissue Distributionsupporting

confidence: 87%

Visceral adiposity, muscle composition, and exercise tolerance in heart failure with preserved ejection fraction

et al. 2021

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“…Several studies of ART-controlled patients have evidenced greater volumes of epicardial fat; along with traditional risk factors for atherosclerosis and the duration of ART, the amount of epicardial fat is associated with the amount of VAT and with insulin resistance. In HIV-infected patients, the epicardial fat volume is related to endothelial dysfunction and the progression of carotid atherosclerosis (187)(188)(189).…”

Section: Atherosclerotic Cardiovascular Diseasementioning

confidence: 99%

Contribution of Adipose Tissue to the Chronic Immune Activation and Inflammation Associated With HIV Infection and Its Treatment

et al. 2021

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White adipose tissue (AT) contributes significantly to inflammation – especially in the context of obesity. Several of AT’s intrinsic features favor its key role in local and systemic inflammation: (i) large distribution throughout the body, (ii) major endocrine activity, and (iii) presence of metabolic and immune cells in close proximity. In obesity, the concomitant pro-inflammatory signals produced by immune cells, adipocytes and adipose stem cells help to drive local inflammation in a vicious circle. Although the secretion of adipokines by AT is a prime contributor to systemic inflammation, the lipotoxicity associated with AT dysfunction might also be involved and could affect distant organs. In HIV-infected patients, the AT is targeted by both HIV infection and antiretroviral therapy (ART). During the primary phase of infection, the virus targets AT directly (by infecting AT CD4 T cells) and indirectly (via viral protein release, inflammatory signals, and gut disruption). The initiation of ART drastically changes the picture: ART reduces viral load, restores (at least partially) the CD4 T cell count, and dampens inflammatory processes on the whole-body level but also within the AT. However, ART induces AT dysfunction and metabolic side effects, which are highly dependent on the individual molecules and the combination used. First generation thymidine reverse transcriptase inhibitors predominantly target mitochondrial DNA and induce oxidative stress and adipocyte death. Protease inhibitors predominantly affect metabolic pathways (affecting adipogenesis and adipocyte homeostasis) resulting in insulin resistance. Recently marketed integrase strand transfer inhibitors induce both adipocyte adipogenesis, hypertrophy and fibrosis. It is challenging to distinguish between the respective effects of viral persistence, persistent immune defects and ART toxicity on the inflammatory profile present in ART-controlled HIV-infected patients. The host metabolic status, the size of the pre-established viral reservoir, the quality of the immune restoration, and the natural ageing with associated comorbidities may mitigate and/or reinforce the contribution of antiretrovirals (ARVs) toxicity to the development of low-grade inflammation in HIV-infected patients. Protecting AT functions appears highly relevant in ART-controlled HIV-infected patients. It requires lifestyle habits improvement in the absence of effective anti-inflammatory treatment. Besides, reducing ART toxicities remains a crucial therapeutic goal.

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“…Furthermore, antiretroviral therapy is known to be associated with MetS and lipodystrophy. EAT has been found to be increased in people infected with HIV on highly active antiretroviral therapy [84,85]. EAT thickness in patients with HIV was correlated with waist circumference, HDL cholesterol level, and plasma triglyceride level [84].…”

Section: Eat and Hivmentioning

confidence: 99%

Epicardial Adipose Tissue: Clinical Biomarker of Cardio-Metabolic Risk

Fricke

Iacobellis

2019

IJMS

117

100

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Epicardial adipose tissue (EAT) is part of the visceral adipose tissue (VAT) that surrounds the heart and it is a quantifiable, modifiable, and multifaceted tissue that has both local and systemic effects. When EAT is enlarged, EAT contributes to atherosclerotic cardiovascular disease (ASCVD) risk and plays a role in the development of metabolic syndrome (MetS). In this review, we will discuss the role of EAT in various facets of MetS, including type 2 diabetes mellitus (T2DM) and insulin resistance. We examine the association between EAT and liver steatosis. We also address the correlations of EAT with HIV therapy and with psoriasis. We discuss racial differences in baseline EAT thickness. We conclude that EAT measurement serves as a powerful potential diagnostic tool in assessing cardiovascular and metabolic risk. Measurement of EAT is made less costly, more convenient, and yet accurate and reliable by transthoracic echocardiography. Furthermore, modification of EAT thickness has therapeutic implications for ASCVD, T2DM, and MetS.

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Regional coronary endothelial dysfunction is related to the degree of local epicardial fat in people with HIV

Abstract: There is a significant relationship between increased metabolically-active EAT and depressed local CEF in people with HIV, consistent with the hypothesis that increased epicardial fat contributes to accelerated CAD in persons with HIV.

Cited by 21 publications

References 44 publications

Visceral adiposity, muscle composition, and exercise tolerance in heart failure with preserved ejection fraction

Visceral adiposity, muscle composition, and exercise tolerance in heart failure with preserved ejection fraction

Contribution of Adipose Tissue to the Chronic Immune Activation and Inflammation Associated With HIV Infection and Its Treatment

Epicardial Adipose Tissue: Clinical Biomarker of Cardio-Metabolic Risk

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