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Description
According to the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), cardiovascular diseases (CVD) account for 29.2% of global deaths each year and have been a leading cause of death in the United States for many decades. Atherosclerosis is the underlying etiology of CVD. Obesity is a risk factor for atherosclerosis and an important risk factor for coronary heart disease (CHD). There are different measures of obesity that include such things as visceral fat, pericardial fat, and liver fat, for example. Pericardial fat may have a significant effect on the development of coronary atherosclerosis due to its proximity to the coronaries and through the local release of inflammatory markers and cytokines. To examine the association between pericardial fat and systemic calcified atherosclerosis, we conducted a study of 394 patients who underwent preventive medicine services, including "whole body" computed tomography, at a University-affiliated disease prevention center. Pericardial fat was measured from the CT scans and health history information was obtained through detailed questionnaires. The exposure variable studied was pericardial fat. The outcome variables were the presence and extent of vascular calcification in the following vascular beds: the carotid arteries, the coronary arteries, the thoracic and abdominal aorta, and the iliac arteries. The total systemic vascular calcification (sum of all calcification scores in each bed) for the beds studied was also analyzed. Standard CVD risk factors of age, gender, BMI, hypertension, smoking status, hyperlipidemia and family history of CVD, as well as visceral fat and total lean muscle, were considered as covariates. Frequencies and descriptive statistics were computed for each variable and correlations were calculated to examine the linear associations between the extent of calcium in each of the vascular beds and pericardial fat. The variables for vascular calcification were then dichotomized into the presence or absence of calcium and logistic regression models were performed to test the association between pericardial fat and vascular calcification adjusting for the CVD risk factors. In secondary analyses, pericardial fat was categorized into quartiles and the previously mentioned logistic regression models were repeated. The average amount of pericardial fat was 177.32 cm_, and the majority of participants (76.14%) had some calcium in one or more of the vascular beds studied. In multivariable logistic regression models adjusted for the CVD risk factors, there was a significant association between pericardial fat and calcified atherosclerosis in the iliac arteries (OR = 2.786, p = 0.0006) and the coronary arteries (OR = 1.669, p = 0.0473). There were no other significant associations between the linear form of pericardial fat and calcium in the other vascular beds. However, compared to those in the lowest quartile, the highest quartile of pericardial fat was associated with higher odds for calcium in the carotid, coronary, thoracic aorta, abdominal aorta, and iliac arteries [3.011 (0.821, 11.047), 1.867 (0.617, 5.655), 1.497 (0.443, 5.06), 3.193 (0.906, 11.247), 8.424 (2.294, 30.926), respectively] after adjusting for all CVD risk factors. Only in the iliac arteries was there a significant relationship between pericardial fat and vascular calcification. Similarly, the highest quartile of pericardial fat was associated with nearly two times higher odds for the presence of calcium in any of the vascular beds [1.968, (0.407, 9.523)] after adjusting for all CVD risk factors. Higher levels of pericardial fat are associated with significantly higher odds for the presence of calcium in several vascular beds, independent of age, gender, BMI, and CVD risk factors. This study is valuable because it examined the association between pericardial fat and vascular calcification outside the coronary arteries. The results derived from this study have important implications for the detection of cardiovascular diseases in that they show that pericardial fat not only has a localized association on vascular calcification but a more systemic association with vascular calcification in other areas of the body such as the iliac arteries.
