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Wu PY, Lee SY, Chang KV, Chao CT, Huang JW. Gender-Related Differences in Chronic Kidney Disease-Associated Vascular Calcification Risk and Potential Risk Mediators: A Scoping Review. Healthcare (Basel) 2021; 9:healthcare9080979. [PMID: 34442116 PMCID: PMC8394860 DOI: 10.3390/healthcare9080979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Vascular calcification (VC) involves the deposition of calcium apatite in vascular intima or media. Individuals of advanced age, having diabetes mellitus or chronic kidney disease (CKD) are particularly at risk. The pathogenesis of CKD-associated VC evolves considerably. The core driver is the phenotypic change involving vascular wall constituent cells toward manifestations similar to that undergone by osteoblasts. Gender-related differences are observed regarding the expressions of osteogenesis-regulating effectors, and presumably the prevalence/risk of CKD-associated VC exhibits gender-related differences as well. Despite the wealth of data focusing on gender-related differences in the risk of atherosclerosis, few report whether gender modifies the risk of VC, especially CKD-associated cases. We systematically identified studies of CKD-associated VC or its regulators/modifiers reporting data about gender distributions, and extracted results from 167 articles. A significantly higher risk of CKD-associated VC was observed in males among the majority of original investigations. However, substantial heterogeneity exists, since multiple large-scale studies yielded neutral findings. Differences in gender-related VC risk may result from variations in VC assessment methods, the anatomical segments of interest, study sample size, and even the ethnic origins of participants. From a biological perspective, plausible mediators of gender-related VC differences include body composition discrepancies, alterations involving lipid profiles, inflammatory severity, diversities in matrix Gla protein (MGP), soluble Klotho, vitamin D, sclerostin, parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), and osteoprotegerin levels. Based on our findings, it may be inappropriate to monotonously assume that male patients with CKD are at risk of VC compared to females, and we should consider more background in context before result interpretation.
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Affiliation(s)
- Patrick Yihong Wu
- School of Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan;
| | - Szu-Ying Lee
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County 640, Taiwan; (S.-Y.L.); (J.-W.H.)
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital BeiHu Branch, Taipei 10845, Taiwan;
| | - Chia-Ter Chao
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei 10845, Taiwan
- Correspondence: ; Tel.: +886-2-23717101 (ext. 6531); Fax: +886-2-23717101
| | - Jenq-Wen Huang
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County 640, Taiwan; (S.-Y.L.); (J.-W.H.)
- Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
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Cano Megías M, Guisado Vasco P, Bouarich H, Lara Aguilera I, de Arriba-de la Fuente G, Rodríguez-Puyol D. Epicardial fat tissue, coronary arterial calcification and mortality in patients with advanced chronic kidney disease and hemodialysis. Nefrologia 2021; 41:174-181. [PMID: 36165378 DOI: 10.1016/j.nefroe.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 09/12/2020] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Epicardial and mediastinal adipose tissue (EAT, MAT) are linked to metabolic syndrome and coronary artery disease. Patients with chronic kidney disease (CKD) have thicker EAT. We assessed if EAT and MAT could be associated with increased mortality and cardiovascular events in patients with advanced CKD and haemodialysis therapy. METHODS A post-hoc study was performed. We analyzed a prospective series of 104 cases. EAT thickness was quantified by a multislice synchronized computed tomography (MSCT). RESULTS The follow-up period was 112.68 (109.94-115.42) months. The optimal cut-off point of EAT for prediction of total mortality was 11.45 mm (92.86% and 43.75%). EAT thickness was associated with serum albumin levels, serum triglyceride levels, phosphorus and calcium phosphate product. The EAT was greater in haemodialysis patients compared to those with advanced CKD (P < .001). Patients with diabetes mellitus had greater EAT and MAT thickness (P = .018). At the end of follow up, the survival average time of patients with EAT thickness <11.45 mm was 97.48 months vs. 76.65 months for thickness > 11.45 mm (P = .007). CONCLUSIONS A higher EAT and MAT thickness was associated with increased mortality. Furthermore, EAT was associated with lower free survival time to fatal and non-fatal cardiovascular events. The measurement of EAT and MAT by MSCT could be a prognostic tool to predict cardiovascular events and mortality risk in advanced CKD patients.
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Affiliation(s)
- Marta Cano Megías
- Endocrinología y Nutrición, Hospital Universitario de Guadalajara, Guadalajara, Spain.
| | - Pablo Guisado Vasco
- Medicina interna, hospital universitario Quironsalud Madrid. Pozuelo de Alarcón. Universidad Europea (Madrid). Spain
| | - Hanane Bouarich
- Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | - Diego Rodríguez-Puyol
- Nefrología, Fundación de Investigación, Hospital Universitario Príncipe de Asturias, Spain
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Ozdemir M, Asoglu R, Dogan Z, Aladag N, Akbulut T, Yurtdas M. The Association of Glomerular Filtration Rate With Echocardiographic Parameters in Chronic Kidney Disease. J Clin Med Res 2021; 13:121-129. [PMID: 33747327 PMCID: PMC7935629 DOI: 10.14740/jocmr4439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in chronic kidney disease (CKD) patients. Aortic propagation velocity (APV), epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) measurements could provide additional information on assessing renal decline in CKD patients. The study aimed to evaluate EFT, AVP and CIMT in CKD patients and then investigate the association among those parameters. Methods A total of 170 CKD consecutive subjects were enrolled in the study. Patients were divided into five groups according to their estimated glomerular filtration rate (eGFR) values. Each patient underwent complete transthoracic echocardiography examination. APV, EFT and CIMT were measured for analyses. A multivariate linear regression model was used for analysis to determine the independent predictors of eGFR. Results The lowest APV was observed in stage IV-V, and the highest APV was observed in stage I-II (P < 0.001). Stage IV-V patients had the highest EFT and stage I-II patients had the lowest EFT (P < 0.001). Moreover, the lowest CIMT was observed in stage III, and the highest CIMT was observed in stage V (P < 0.001). eGFR was significantly and positively correlated with APV and negatively correlated with EFT and CIMT. In multivariate analyses, APV (odds ratio (OR): 0.289, P < 0.001), EFT (OR: -0.135, P < 0.001) and CIMT (OR: -0.388, P < 0.001) were independent predictors of eGFR. Conclusion We found that APV decreased, and EFT and CIMT increased as CKD progress. The present study suggests that APV, EFT and CIMT might be incorporated with the examination of CKD patients in daily practice.
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Affiliation(s)
- Mahmut Ozdemir
- Cardiology Department, School of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Ramazan Asoglu
- Cardiology Department, Adiyaman University Training and Research Hospital, Adiyaman, Turkey
| | - Zeki Dogan
- Cardiology Department, School of Medicine, Istanbul Atlas University, Istanbul, Turkey
| | - Nesim Aladag
- Cardiology Department, School of Medicine, Yuzuncuyil University, Van, Turkey
| | - Tayyar Akbulut
- Cardiology Department, Van Training and Research Hospital, Health Science University, Van, Turkey
| | - Mustafa Yurtdas
- Cardiology Department, School of Medicine, Istanbul Atlas University, Istanbul, Turkey
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Epicardial adipose tissue in patients with chronic kidney disease: a meta-analysis study and trial sequential analysis. Int Urol Nephrol 2020; 52:2345-2355. [PMID: 32720030 DOI: 10.1007/s11255-020-02575-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death in patients with chronic kidney disease (CKD). Epicardial adipose tissue (EAT) is an independent predictor of cardiovascular disease in the general population, and usually increases in the patients with cardiovascular disease risk. The change of EAT in patients with CKD was still controversial. For further understanding, we conducted a meta-analysis of the relevant literature. METHODS Eligible studies were searched in PubMed, EMBASE, Web of Science, and Scopus on March 13, 2020. The summarized standard mean difference (SMD) with 95% confidence intervals (CIs) were used to assess the association between EAT (thickness and volume) and CKD. Trial sequential analysis was conducted to estimate whether the evidence of the results is sufficient. RESULTS In total, 17 studies with 1961 participants (1205 patients in the CKD group and 756 participants in the control group) were involved. The EAT thickness was significantly increased in the CKD group compared to the control group (SMD = 1.31, 95% CI 0.89-1.73, P < 0.001) in eleven studies. The EAT volume was significantly increased in the CKD group compared to the control group (SMD = 0.77, 95% CI 0.63-0.91, P < 0.001) in six studies. Trial sequential analysis indicated that the available samples were sufficient and confirmed that firm evidence was reached. CONCLUSIONS Patients with CKD have higher EAT thickness and volume compared to control subjects without CKD.
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Kleinaki Z, Agouridis AP, Zafeiri M, Xanthos T, Tsioutis C. Epicardial adipose tissue deposition in patients with diabetes and renal impairment: Analysis of the literature. World J Diabetes 2020; 11:33-41. [PMID: 32064034 PMCID: PMC6969709 DOI: 10.4239/wjd.v11.i2.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates. Renal disease in patients with diabetes is associated with increased morbidity and premature mortality, particularly attributed to their very high cardiovascular risk. Since this group of patients frequently lacks specific symptomatology prior to the adverse events, a screening tool for the identification of high-risk patients is necessary. The epicardial adipose tissue (EAT) is a biologically active organ having properties similar to visceral adipose tissue and has been associated with metabolic diseases and coronary artery disease. Superior to conventional cardiovascular risk factors and anthropometric measures, including body mass index and waist circumference, the EAT can early predict the development of coronary artery disease. Assessment of EAT can be performed by two-dimensional echocardiography, magnetic resonance imaging or computer tomography. However, its role and significance in patients with DM and nephropathy has not been thoroughly evaluated. The aim of the current editorial is to evaluate all available evidence regarding EAT in patients with DM and renal impairment. Systematic search of the literature revealed that patients with DM and nephropathy have increased EAT measurements, uncontrolled underlying disease, high body mass index and raised cardiovascular risk markers. Acknowledging the practical implications of this test, EAT assessment could serve as a novel and non-invasive biomarker to identify high-risk patients for cardiovascular adverse events.
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Affiliation(s)
- Zoi Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
| | - Aris P Agouridis
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
| | - Maria Zafeiri
- Diabetes and Obesity Center, Konstantopouleio Hospital, Athens 14233, Greece
| | - Theodoros Xanthos
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
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Yilmaz Z, İnce H, Aydin E, Yildirim Y, Yilmaz Aydin F, Yüksel E, Karabulut A, Dursun L, Kadiroğlu AK, Yilmaz ME. Relationship Between Epicardial Adipose Tissue and Body Composition as Determined by Multi-Frequency Bioelectrical Impedance Analysis in Patients with Stage 5 Chronic Kidney Disease. Med Sci Monit 2020; 26:e920233. [PMID: 32029697 PMCID: PMC7020765 DOI: 10.12659/msm.920233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The main cause of mortality among chronic kidney disease (CKD) patients is cardiovascular disease (CVD). Epicardial adipose tissue (EAT) is considered to be novel cardiovascular risk factor. We assessed EAT in non-dialyzed stage 5 CKD patients and explored the association of EAT with body composition as determined by multi-frequency BIA. Material/Methods The present included 70 stage 5 CKD patients who had not undergone dialysis and 40 healthy control subjects. EAT thickness was assessed by echocardiography. Hydration status and body composition were evaluated by multi-frequency bioelectrical impedance analysis. Results Stage 5 CKD patients had significantly higher EAT thickness than healthy subjects (6.56±1.18 vs. 4.05±1.45, p<0.001). Fat tissue mass, systolic blood pressure (SBP), age, fat tissue index, and body mass index were positively correlated with EAT thickness in the CKD patient group (p<0.05). Lean tissue mass, lean tissue index (LTI), and high-density lipoprotein (HDL) were negatively correlated with EAT thickness in the CKD patient group (p<0.05). Stepwise multiple regression analysis showed that age, SBP, and LTI were independently associated with EAT thickness in CKD patients. Conclusions We found significantly higher EAT thickness in stage 5 CKD patients who were not on dialysis compared to healthy controls. EAT was significantly associated with age, SBP, and LTI in CKD patients. Interventions to reduce the risk factors associated with EAT thickness might protect against CVD disease in CKD patients.
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Affiliation(s)
- Zülfükar Yilmaz
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Hasan İnce
- Department of Internal Medicine, Selahattin Eyyübi State Hospital, Diyarbakir, Turkey
| | - Emre Aydin
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Yasar Yildirim
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Fatma Yilmaz Aydin
- Department of Internal Medicine, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Enver Yüksel
- Department of Nephrology, Gazi Yasargil Education Research Hospital, Diyarbakir, Turkey
| | - Aziz Karabulut
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Lezgin Dursun
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Ali Kemal Kadiroğlu
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Mehmet Emin Yilmaz
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Epicardial Adipose Tissue and Renal Disease. J Clin Med 2019; 8:jcm8030299. [PMID: 30832377 PMCID: PMC6463003 DOI: 10.3390/jcm8030299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 01/09/2023] Open
Abstract
Epicardial adipose tissue (EAT) is derived from splanchnic mesoderm, localized anatomically between the myocardium and pericardial visceral layer, and surrounds the coronary arteries. Being a metabolically active organ, EAT secretes numerous cytokines, which moderate cardiovascular morphology and function. Through its paracrine and vasocrine secretions, EAT may play a prominent role in modulating cardiac function. EAT protects the heart in normal physiological conditions by secreting a variety of adipokines with anti-atherosclerotic properties, and in contrast, secretes inflammatory molecules in pathologic conditions that may play a dynamic role in the pathogenesis of cardiovascular diseases by promoting atherosclerosis. Considerable research has been focused on comparing the anatomical and biochemical features of EAT in healthy people, and a variety of disease conditions such as cardiovascular diseases and renal diseases. The global cardiovascular morbidity and mortality in renal disease are high, and there is a paucity of concrete evidence and societal guidelines to detect early cardiovascular disease (CVD) in this group of patients. Here we performed a clinical review on the existing evidence and knowledge on EAT in patients with renal disease, to evaluate its application as a reliable, early, noninvasive biomarker and indicator for CVD, and to assess its significance in cardiovascular risk stratification.
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Gok Oguz E, Akoglu H, Ulusal Okyay G, Karaveli Gursoy G, Yildirim T, Merhametsiz O, Cimen T, Canbakan B, Yeter E, Ayli MD. Increased serum renalase in peritoneal dialysis patients: Is it related to cardiovascular disease risk? Nefrologia 2017; 37:189-194. [PMID: 28160962 DOI: 10.1016/j.nefro.2016.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 10/12/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Renalase, with possible monoamine oxidase activity, is implicated in degradation of catecholamines; which suggests novel mechanisms of cardiovascular complications in patients with chronic kidney diseases. Epicardial adipose tissue (EAT) has been found to correlate with cardiovascular diseases (CVD) in dialysis patients. The present study aimed to evaluate the association of serum renalase levels with EAT thickness and other CVD risk factors in peritoneal dialysis (PD) patients. METHODS The study included 40 PD patients and 40 healthy controls. All subjects underwent blood pressure and anthropometric measurements. Serum renalase was assessed by using a commercially available assay. Transthoracic echocardiography was used to measure EAT thickness and left ventricular mass index (LVMI) in all subjects. RESULTS The median serum renalase level was significantly higher in the PD patients than in the control group [176.5 (100-278.3) vs 122 (53.3-170.0)ng/ml] (p=0.001). Renalase was positively correlated with C-reactive protein (r=0.705, p<0.001) and negatively correlated with RRF (r=-0.511, p=0.021). No correlation was observed between renalase and EAT thickness or LVMI. There was a strong correlation between EAT thickness and LVMI in both the PD patients and the controls (r=0.848, p<0.001 and r=0.640, p<0.001 respectively). CONCLUSIONS This study indicates that renalase is associated with CRP and residual renal function but not with EAT thickness as CVD risk factors in PD patients.
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Affiliation(s)
- Ebru Gok Oguz
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey.
| | - Hadim Akoglu
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Gulay Ulusal Okyay
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Guner Karaveli Gursoy
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Tolga Yildirim
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Ozgur Merhametsiz
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Tolga Cimen
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Basol Canbakan
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Ekrem Yeter
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - M Deniz Ayli
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
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Assessment of the relationship between serum paraoxonase activity and epicardial adipose tissue in hemodialysis patients. Int Urol Nephrol 2016; 49:329-335. [DOI: 10.1007/s11255-016-1465-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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Epicardial adipose tissue in patients with end-stage renal disease on haemodialysis. Curr Opin Nephrol Hypertens 2016; 24:517-24. [PMID: 26335554 DOI: 10.1097/mnh.0000000000000161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Epicardial adipose tissue (EAT) is the visceral fat of the heart, sharing many of the pathophysiological properties of other visceral fat depots. EAT is a metabolically active paracrine and vasocrine organ that causes local cardiac inflammation and is strongly implicated in the pathogenesis of coronary atherosclerosis. This article highlights the findings of recent observational studies in patients on haemodialysis that link the quantity of EAT to increased rates of cardiovascular and coronary artery disease and review the proposed methods of pathogenesis and the possible role of EAT quantification to improve cardiovascular risk assessment. RECENT FINDINGS Increasing volumes of EAT in patients on haemodialysis correlate with increased inflammatory mediators, higher rates of cardiovascular disease and coronary artery calcification, independent of general adiposity. EAT is an independent predictor of mortality and a potentially modifiable target for therapeutic interventions. SUMMARY EAT is likely to play a central role in the pathogenesis of cardiovascular disease in patients on haemodialysis, adds incrementally to conventional cardiovascular risk stratification models and is a potential target for therapeutic intervention.
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Yang C, Li L, Zha Y, Peng Z. Correlation between epicardial adipose tissue and severity of coronary artery stenosis evaluated by 64-MDCT. Clin Imaging 2015; 40:477-80. [PMID: 27133690 DOI: 10.1016/j.clinimag.2015.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/23/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose was to investigate the correlation between epicardial adipose tissue (EAT) thickness, EAT volume, and severity of coronary artery stenosis. METHODS We retrospectively enrolled 188 patients that underwent coronary computed tomography (CT) angiography for clinically suspected coronary artery disease using 64-MDCT. Images were reconstructed using a retrospective electrocardiogram-gated algorithm with 0.625-mm-thick sections. EAT thickness and volume were calculated. RESULTS The coronary CT angiography showed 106 patients who had coronary artery pathology (178 lesions), 21 patients with moderate stenosis (27 lesions), 12 patients with severe stenosis (18 lesions), and 6 patients with complete occlusion (8 lesions). EAT thickness, EAT volume, and Gensini score were statistically different among groups (FT=32.306, FV=27.743, F=110.483, P=.000). Pearson correlation analysis showed that Gensini score had significantly positive correlation with EAT thickness and volume, respectively. CONCLUSION EAT thickness and volume demonstrated a positive correlation with severity of coronary artery stenosis.
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Affiliation(s)
- Chunying Yang
- Department of Radiology, the Huaihe Hospital of Henan University, Henan, Kaifeng, 475000, PR China; Department of Radiology, the People's Hospital of Wuhan University, Wuhan, 430060, PR China
| | - Liang Li
- Department of Radiology, the Huaihe Hospital of Henan University, Henan, Kaifeng, 475000, PR China
| | - Yunfei Zha
- Department of Radiology, the People's Hospital of Wuhan University, Wuhan, 430060, PR China.
| | - Zhoufeng Peng
- Department of Radiology, the People's Hospital of Wuhan University, Wuhan, 430060, PR China
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Barros X, Dirrichs T, Koos R, Reinartz S, Kaesler N, Kramann R, Gladziwa U, Ketteler M, Floege J, Marx N, Torregrosa JV, Keszei A, Brandenburg VM. Epicardial adipose tissue in long-term hemodialysis patients: its association with vascular calcification and long-term development. J Nephrol 2015; 29:241-250. [PMID: 26253562 DOI: 10.1007/s40620-015-0221-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/11/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) in the general population. EAT is suggested to promote CAD by paracrine mechanisms and local inflammation. We evaluated whether in chronic hemodialysis (HD) patients EAT associates with CAD, how the amount of EAT develops over time, and if EAT independently predicts the mortality risk. METHODS Post-hoc analysis of a prospective study in 59 chronic HD patients who underwent non-enhanced multi-slice computed tomography (MSCT) at baseline. Thirty-seven patients underwent another MSCT after 24 ± 5 months. We measured EAT volume (cm³) and Agatston calcification scores of coronary arteries (CAC) and aortic valves (AVC). All-cause mortality was assessed after a follow-up of 88 months (IQR 52-105). RESULTS Baseline EAT was 128.2 ± 60.8 cm³ and significantly higher than in a control group of non-renal patients (94 ± 46 cm³; p < 0.05). Median Agatston score for CAC was 329 (IQR 23-1181) and for AVC was 0 (IQR 0-25.3) in HD patients. We observed significant positive correlations between baseline EAT and age (r = 0.386; p = 0.003), BMI (r = 0.314; p = 0.016), CAC (r = 0.278; p = 0.03), and AVC (r = 0.282; p = 0.03). In multivariate analysis, age, BMI and AVC remained as significant predictors of EAT (p < 0.01). Calcification scores significantly increased over 2 years; in contrast EAT change was not significant (+11 %, IQR -10 to 24 %; p = 0.066). The limited patient number in the present study precludes analysis of the EAT impact upon survival. CONCLUSION EAT correlated significantly with cardiovascular calcification in long-term HD patients. Mean EAT did not significantly change over 2 years.
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Affiliation(s)
- Xoana Barros
- Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany. .,Department of Nephrology, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Spain.
| | - Timm Dirrichs
- Department of Radiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Ralf Koos
- Department of Cardiology, Städtische Kliniken Mönchengladbach GmbH, Elisabeth-Krankenhaus Rheydt, Rheydt, Germany
| | - Sebastian Reinartz
- Department of Radiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Nadine Kaesler
- Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Rafael Kramann
- Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Ulrich Gladziwa
- Dialysis Center, Kuratorium für Heimdialyse (KfH), Würselen, Germany
| | | | - Jürgen Floege
- Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - José V Torregrosa
- Department of Nephrology, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - András Keszei
- Department of Medical Informatics, University Hospital of the RWTH Aachen, Aachen, Germany
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Eroglu E, Kocyigit I, Unal A, Korkar H, Karakukcu C, Orscelik O, Sipahioglu MH, Tokgoz B, Oymak O. Serum paraoxonase activity is associated with epicardial fat tissue in renal transplant recipients. Int Urol Nephrol 2015; 47:1409-14. [PMID: 26184836 DOI: 10.1007/s11255-015-1051-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
AIMS Cardiovascular disease is a major cause of mortality in renal transplant recipients. Paraoxonase-1 (PON-1) has been shown to protect against atherosclerosis by modifying lipoproteins. Epicardial fat tissue (EFT) has been proposed as a new cardiovascular risk factor. The aim of this study was to investigate the relationship between PON-1 activity and EFT in renal transplant recipients. METHODS Eighty renal transplant recipients were enrolled in this cross-sectional study. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. EFT was measured by echocardiography. RESULTS The mean age of the patients was 40.4 ± 12.3 years and mean post transplant follow-up duration was 57.2 ± 46 months. Mean PON-1 activity was 68.5 ± 30 U/L. PON-1 activity was positively correlated with age and body mass index and negatively correlated with parathyroid hormone, dialysis duration and EFT. The mean EFT thickness was 0.64 ± 0.17 cm. Multiple linear regression analysis was used to define independent determinants of EFT in renal transplant recipients. According to linear regression analysis, PON-1 levels and age were found to be independent predictors of EFT. CONCLUSION Reduced PON-1 activity was negatively associated with EFT and PON-1 activity independently predicts EFT in renal transplant recipients.
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Affiliation(s)
- Eray Eroglu
- Department of Internal Medicine, Erciyes University Medical School, Kayseri, Turkey,
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14
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Cordeiro AC, Amparo FC, Oliveira MAC, Amodeo C, Smanio P, Pinto IMF, Lindholm B, Stenvinkel P, Carrero JJ. Epicardial fat accumulation, cardiometabolic profile and cardiovascular events in patients with stages 3-5 chronic kidney disease. J Intern Med 2015; 278:77-87. [PMID: 25556720 DOI: 10.1111/joim.12344] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND It has been hypothesized that epicardial adipose tissue (EAT) exerts pathogenic effects on cardiac structures. We analysed the associations between EAT and both cardiovascular (CV) disease risk factors and CV events in patients with chronic kidney disease (CKD). PATIENTS AND METHODS We included 277 nondialysed patients [median age 61, interquartile range (IQR) 53-68 years; 63% men] with stages 3-5 CKD in this cross-sectional evaluation. EAT and abdominal visceral adipose tissue (VAT) were assessed by computed tomography. Patients were followed for median 32 (IQR 20-39) months, and the composite of fatal and nonfatal CV events was recorded. RESULTS With increasing EAT quartiles, patients were older, had higher glomerular filtration rate, body mass index, waist, VAT and coronary calcification, higher levels of haemoglobin, triglycerides, albumin, C-reactive protein and leptin and higher prevalence of left ventricular hypertrophy and myocardial ischaemia; total and high-density lipoprotein cholesterol, 25-hydroxy-vitamin D and 1, 25-dihydroxy-vitamin D progressively decreased. Associations between EAT and cardiac alterations were not independent of VAT. During follow-up, 58 CV events occurred. A 1-SD higher EAT volume was associated with an increased risk of CV events in crude [hazard ratio (HR) 1.41, 95% confidence interval (CI) (1.12-1.78) and adjusted (HR 1.55, 95% CI 1.21-1.99) Cox models. However, adding EAT to a standard CV disease risk prediction model did not result in a clinically relevant improvement in prediction. CONCLUSION Epicardial adipose tissue accumulation in patients with CKD increases the risk of CV events independent of general adiposity. This is consistent with the notion of a local pathogenic effect of EAT on the heart or heart vessels, or both. However, EAT adds negligible explanatory power to standard CV disease risk factors.
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Affiliation(s)
- A C Cordeiro
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - F C Amparo
- Department of Nutrition, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - M A C Oliveira
- Department of Nuclear Medicine, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - C Amodeo
- Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - P Smanio
- Department of Nuclear Medicine, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - I M F Pinto
- Department of Radiology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - B Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - P Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - J J Carrero
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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15
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Ulusal Okyay G, Okyay K, Polattaş Solak E, Sahinarslan A, Paşaoğlu Ö, Ayerden Ebinç F, Paşaoğlu H, Boztepe Derici Ü, Sindel Ş, Arınsoy T. Echocardiographic epicardial adipose tissue measurements provide information about cardiovascular risk in hemodialysis patients. Hemodial Int 2015; 19:452-62. [DOI: 10.1111/hdi.12276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Gülay Ulusal Okyay
- Nephrology Department; Gazi University Faculty of Medicine; Ankara Turkey
| | - Kaan Okyay
- Cardiology Department; Başkent University Faculty of Medicine; Ankara Turkey
| | | | - Asife Sahinarslan
- Cardiology Department; Gazi University Faculty of Medicine; Ankara Turkey
| | - Özge Paşaoğlu
- Biochemistry Department; Gazi University Faculty of Medicine; Ankara Turkey
| | | | - Hatice Paşaoğlu
- Biochemistry Department; Gazi University Faculty of Medicine; Ankara Turkey
| | | | - Şükrü Sindel
- Nephrology Department; Gazi University Faculty of Medicine; Ankara Turkey
| | - Turgay Arınsoy
- Nephrology Department; Gazi University Faculty of Medicine; Ankara Turkey
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16
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Çolak H, Kilicarslan B, Tekce H, Tanrisev M, Tugmen C, Aktas G, Kursat S. Relationship Between Epicardial Adipose Tissue, Inflammation and Volume Markers in Hemodialysis and Transplant Patients. Ther Apher Dial 2015; 19:56-62. [PMID: 25628169 DOI: 10.1111/1744-9987.12276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hülya Çolak
- Department of Nephrology; Tepecik Education and Research Hospital; Izmir Turkey
| | - Baris Kilicarslan
- Department of Cardiology; Tepecik Education and Research Hospital; Izmir Turkey
| | - Hikmet Tekce
- Department of Nephrology; Abant Izzet Baysal University; Bolu Turkey
| | - Mehmet Tanrisev
- Department of Nephrology; Tepecik Education and Research Hospital; Izmir Turkey
| | - Cem Tugmen
- Department of Surgery; Tepecik Education and Research Hospital; Izmir Turkey
| | - Gulali Aktas
- Department of Internal Medicine; Faculty of Medicine; Abant Izzet Baysal University; Bolu Turkey
| | - Seyhun Kursat
- Department of Nephrology; Faculty of Medicine; Celal Bayar University; Manisa Turkey
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17
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Carrero JJ, Avesani CM. Pros and Cons of Body Mass Index as a Nutritional and Risk Assessment Tool in Dialysis Patients. Semin Dial 2014; 28:48-58. [DOI: 10.1111/sdi.12287] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Juan Jesús Carrero
- Divisions of Renal Medicine and Baxter Novum; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Center for Molecular Medicine; Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
| | - Carla Maria Avesani
- Department of Applied Nutrition; Nutrition Institute; Rio de Janeiro State University; Rio de Janeiro Brazil
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18
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Kocyigit I, Gungor O, Unal A, Yasan M, Orscelik O, Tunca O, Eroglu E, Sipahioglu MH, Tokgoz B, Ozdogru I, Dogan A, Oymak O. A low serum free triiodothyronine level is associated with epicardial adipose tissue in peritoneal dialysis patients. J Atheroscler Thromb 2014; 21:1066-74. [PMID: 24898381 DOI: 10.5551/jat.23259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Cardiovascular disease is a major cause of mortality in dialysis patients. Epicardial adipose tissue (EAT) has been proposed as a cardiovascular risk marker in this population. Subclinical hypothyroidism and low free triiodothyronine (fT3) levels are associated with EAT in patients without chronic renal failure. The aim of this study was to investigate the relationship between EAT and low free T3 levels in peritoneal dialysis (PD) patients. METHODS A total of 125 prevalent PD patients were enrolled in this cross-sectional study. The epicardial fat thickness (EFT) was measured by echocardiography, and the endothelial function was assessed by flow mediated dilatation (FMD). Thyroid function tests were performed by an enzyme immunoassay. RESULTS The mean age of the patients was 51 ± 13, and the time on PD was 36 months. The mean EFT was 6.7 ± 2.9 mm. The EFT correlated positively with the patient age, systolic blood pressure (BP), mean BP, high sensitivity C-reactive protein (hs-CRP) level and body mass index (BMI), and negatively with the fT3 level and FMD. The median fT3 value was 2.53, and patients were divided according to their serum fT3 values (within the normal range and below the reference level). Compared with patients in the low fT3 group, the subjects in the normal fT3 group had higher serum albumin levels and FMD, but a lower BMI, plasma fasting glucose level, EFT, TSH level, hs-CRP level, low density lipoprotein (LDL) cholesterol level and mean BP in office measurements, and both the diastolic BP and mean BP by ambulatory blood pressure measurement. A multivariate linear regression analysis showed that the EFT was predicted by the hs-CRP and fT3 levels. CONCLUSION Low free T3 levels are associated with the epicardial fat thickness in PD patients. Further studies are needed to evaluate the pathogenesis and to support these findings.
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Affiliation(s)
- Ismail Kocyigit
- Department of Nephrology, Erciyes University Medical Faculty
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19
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Macunluoglu B, Atakan A, Ari E, Kaya Y, Kaspar C, Demir H, Alp HH. Epicardial fat tissue thickness is correlated with diminished levels of co-enzyme Q10, a major antioxidant molecule among hemodialysis patients. Clin Biochem 2014; 47:1231-4. [PMID: 24882509 DOI: 10.1016/j.clinbiochem.2014.05.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Accelerated atherosclerosis is the major cause of mortality in patients on chronic maintenance hemodialysis (HD). Epicardial fat tissue (EFT) is a new risk factor in cardiovascular disease (CVD). The aim of this study was to evaluate the relation between plasma coenzyme Q10 levels (Co-Q10) which is a potent physiologic antioxidant and EFT thickness in HD patients. DESIGN AND METHODS Seventy one chronic HD patients and 65 age and sex matched healthy individuals were included in the study. Plasma Co-Q10 levels were performed by high-performance liquid chromatography (HPLC) measurements. EFT was measured by transthoracic echocardiograpy (TTE) performed with a VIVID 7 instrument. RESULTS Plasma Co-Q10 levels (1.36±0.43 vs 2.53±0.55, p<0.001) were significantly lower in HD patients compared to controls. EFT was significantly increased in HD patients compared to healthy controls (6.53±1.01 vs. 5.79±1.06 mm respectively, p<0.001). Correlation analysis showed that plasma Co-Q10 levels were inversely correlated with EFT (r=-0.263, p<0.05). Multiple linear regression analysis was used to define independent determinants of EFT in HD patients. According to linear regression analysis, age, BMI, total cholesterol and Co-Q10 levels were found to be independent predictors of EFT (adjusted r(2)=0.38, p<0.001). CONCLUSION This study demonstrated that EFT thickness was significantly higher among HD patients compared to healthy controls. In addition; this study was the first to demonstrate an inverse correlation between EFT thickness and Co-Q10 levels in this patient population.
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Affiliation(s)
- Beyza Macunluoglu
- Department of Nephrology, Uskudar State Hospital, 34000 Istanbul, Turkey.
| | - Aydin Atakan
- Department of Nephrology, Fatih Sultan Mehmet State Hospital, 34000 Istanbul, Turkey.
| | - Elif Ari
- Department of Nephrology, Van Yuksek Ihtisas Hospital, 65200 Van, Turkey.
| | - Yüksel Kaya
- Department of Cardiology, Van Yuksek Ihtisas Hospital, 65200 Van, Turkey.
| | - Cigdem Kaspar
- Department of Biostatistics, Yeditepe University, 34000 İstanbul, Turkey..
| | - Halit Demir
- Department of Biochemistry, Yuzuncu Yil University, 65000 Van, Turkey.
| | - Hamit Hakan Alp
- Department of Biochemistry, Yuzuncu Yil University, 65000 Van, Turkey.
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20
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Abstract
PURPOSE OF REVIEW We comment on the associations between epicardial adiposity and cardiovascular disease (CVD) and associated risk factors. The effects of lifestyle measures and CVD drugs on cardiac adipose tissue are also discussed. RECENT FINDINGS Epicardial adipose tissue exerts cardioprotective properties; however, in cases of pathological enlargement, epicardial fat can lead to myocardial inflammation and dysfunction as well as left ventricular hypertrophy and coronary artery disease (CAD) due to paracrine actions that include increased production of reactive oxygen species, atherogenic and inflammatory cytokines. Cardiac adiposity is associated with CAD, obesity, type 2 diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and chronic kidney disease, as well as with CVD risk factors such as lipids, hypertension, obesity markers, and carotid atherosclerosis. SUMMARY Due to its anatomical and functional proximity to the coronary circulation, epicardial adipose tissue may represent an even more direct CVD risk marker than central adiposity. Lifestyle measures and certain drugs may affect its thickness, although there are limited data currently available. The clinical implications of epicardial fat in daily practice remain to be established in future studies.
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21
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Alexopoulos N, Katritsis D, Raggi P. Visceral adipose tissue as a source of inflammation and promoter of atherosclerosis. Atherosclerosis 2014; 233:104-12. [PMID: 24529130 DOI: 10.1016/j.atherosclerosis.2013.12.023] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 12/31/2022]
Abstract
The current epidemic of obesity with the associated increasing incidence of insulin resistance, diabetes mellitus and atherosclerosis affecting a large proportion of the North American and Western populations, has generated a strong interest in the potential role of visceral adipose tissue in the development of atherosclerosis and its complications. The intra-abdominal and epicardial space are two compartments that contain visceral adipose tissue with a similar embryological origin. These visceral fats are highly inflamed in obese patients, patients with the metabolic syndrome and in those with established coronary artery disease; additionally they are capable of secreting large quantities of pro-inflammatory cytokines and free fatty acids. There is accumulating evidence to support a direct involvement of these regional adipose tissue deposits in the development of atherosclerosis and its complicating events, as will be reviewed in this article.
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Affiliation(s)
| | | | - Paolo Raggi
- Division of Cardiology, Department of Medicine, University of Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
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22
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Altun B, Tasolar H, Eren N, Binnetoğlu E, Altun M, Temiz A, Gazi E, Barutcu A, Altunoren O, Colkesen Y, Uysal F. Epicardial Adipose Tissue Thickness in Hemodialysis Patients. Echocardiography 2013; 31:941-6. [DOI: 10.1111/echo.12498] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Burak Altun
- Department of Cardiology; Canakkale Onsekiz Mart University; Canakkale Turkey
| | - Hakan Tasolar
- Department of Cardiology; Adiyaman University Training and Research Hospital; Adiyaman Turkey
| | - Necmi Eren
- Department of Nephrology; Adiyaman University Training and Research Hospital; Adiyaman Turkey
| | - Emine Binnetoğlu
- Department of Internal Medicine; Canakkale Onsekiz Mart University; Canakkale Turkey
| | - Mehzat Altun
- Vocational Health College; Canakkale Onsekiz Mart University; Canakkale Turkey
| | - Ahmet Temiz
- Department of Cardiology; Canakkale Onsekiz Mart University; Canakkale Turkey
| | - Emine Gazi
- Department of Cardiology; Canakkale Onsekiz Mart University; Canakkale Turkey
| | - Ahmet Barutcu
- Department of Cardiology; Canakkale Onsekiz Mart University; Canakkale Turkey
| | - Orcun Altunoren
- Department of Nephrology; Adiyaman University Training and Research Hospital; Adiyaman Turkey
| | - Yucel Colkesen
- Department of Cardiology; Canakkale Onsekiz Mart University; Canakkale Turkey
| | - Fatma Uysal
- Department of Radiology; Canakkale Onsekiz Mart University; Canakkale Turkey
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23
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Atakan A, Macunluoglu B, Kaya Y, Ari E, Demir H, Asicioglu E, Kaspar C. Epicardial fat thickness is associated with impaired coronary flow reserve in hemodialysis patients. Hemodial Int 2013; 18:62-9. [DOI: 10.1111/hdi.12091] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Aydin Atakan
- Department of Nephrology; Fatih Sultan Mehmet State Hospital; Istanbul Turkey
| | | | - Yuksel Kaya
- Department of Cardiology; Van Yuksek Ihtisas Hospital; Van Turkey
| | - Elif Ari
- Department of Nephrology; Van Yuksek Ihtisas Hospital; Van Turkey
| | - Halit Demir
- Department of Biochemistry; Yuzuncu Yil University; Van Turkey
| | - Ebru Asicioglu
- Department of Nephrology; Marmara University; Istanbul Turkey
| | - Cigdem Kaspar
- Department of Biostatistics; Yeditepe University; Istanbul Turkey
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D'Marco LG, Bellasi A, Kim S, Chen Z, Block GA, Raggi P. Epicardial adipose tissue predicts mortality in incident hemodialysis patients: a substudy of the Renagel in New Dialysis trial. Nephrol Dial Transplant 2013; 28:2586-95. [PMID: 23904396 DOI: 10.1093/ndt/gft264] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) has been described in the general population as an independent risk marker for incident coronary artery disease. In hemodialysis patients, it correlates with other markers of cardiovascular disease, but it is unknown if it is associated with adverse events. METHODS post hoc analysis of the Renagel in New Dialysis (RIND) patients study, a randomized trial of sevelamer versus calcium-based phosphate binders in 109 incident hemodialysis patients, followed for all-cause mortality for a median of 49.3 months. Patients underwent baseline cardiac computed tomography imaging within 120 days of dialysis initiation. RESULTS Baseline EAT measurements were available in 95 patients; EAT was positively correlated with age, body mass index, triglycerides, C-reactive protein, coronary artery calcium and aortic calcium, and negatively correlated with systolic and diastolic blood pressure, serum high density lipoprotein (HPL) cholesterol and serum phosphate (all P < 0.05). During follow-up, a total of 27 (28.4%) patients expired [mortality per 1000 patients/year: 95% confidence interval (95% CI) = 77 (64-94)]. Five-year survival rate was 44. 6% (95% CI: 21.1-65.7) and 71.2% (95% CI: 45.95-86.25) in patients with EAT above or below the median, respectively. Each 10 cc increase in EAT volume was associated with a significant 6% increase in the risk of death during follow-up [hazard ratio (HR): 1.060; 95% CI: 1.013-1.109; P-value = 0.012]. CONCLUSIONS In this subanalysis of a randomized trial, EAT was an independent predictor of mortality in incident hemodialysis patients after ~4 years of follow-up. These hypothesis-generating findings will need confirmatory evidence.
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Affiliation(s)
- Luis G D'Marco
- Department of Nephrology, Hospital Universitario Ruíz y Páez, Universidad de Oriente, Ciudad Bolívar, Venezuela
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Balta S, Demirkol S, Arslan Z, Unlu M, Kucuk U, Iyisoy A. Epicardial Fat Thickness Should Be Evaluated with Other Inflammatory Markers and Cardiovascular Risk Factors. Echocardiography 2013; 30:739. [DOI: 10.1111/echo.12196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sevket Balta
- Department of Cardiology; Gulhane Medical Academy, Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology; Gulhane Medical Academy, Ankara, Turkey
| | - Zekeriya Arslan
- Department of Cardiology; Gulhane Medical Academy, Ankara, Turkey
| | - Murat Unlu
- Department of Cardiology; Gulhane Medical Academy, Ankara, Turkey
| | - Ugur Kucuk
- Department of Cardiology; Gulhane Medical Academy, Ankara, Turkey
| | - Atila Iyisoy
- Department of Cardiology; Gulhane Medical Academy, Ankara, Turkey
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Balta S, Demırkol S, Kucuk U, Arslan Z, Unlu M, Yesil FG. Epicardial adipose tissue should be evaluated with other inflammatory markers in patients with subclinical hypothyroidism. Med Princ Pract 2013; 22:603. [PMID: 23571477 PMCID: PMC5586789 DOI: 10.1159/000350422] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Sevket Balta
- *Dr. Sevket Balta, Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam Street, TR-06018 Etlik-Ankara (Turkey), E-Mail
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Balta S, Demirkol S, Kucuk U, Unlu M, Dinc M, Arslan Z. Epicardial Fat Thickness and Cardio-Ankle Vascular Index without Other Inflammatory Markers May Not Provide Information to Clinicians about the Systemic Inflammation. Cardiology 2013; 125:13-4. [DOI: 10.1159/000348339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 01/22/2013] [Indexed: 11/19/2022]
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