Novel combined index of cardiometabolic risk related to periarterial fat improves the clinical prediction for coronary artery disease complexity

Perivascular adipose tissue in autoimmune rheumatic diseases

Perivascular adipose tissue (PVAT) resides at the outermost boundary of the vascular wall, surrounding most conduit blood vessels, except for the cerebral vessels, in humans. A growing body of evidence suggests that inflammation localized within PVAT may contribute to the pathogenesis of cardiovascular disease (CVD). Patients with autoimmune rheumatic diseases (ARDs), e.g., systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriasis, etc., exhibit heightened systemic inflammation and are at increased risk for CVD. Data from clinical studies in patients with ARDs support a linkage between dysfunctional adipose tissue, and PVAT in particular, in disease pathogenesis. Here, we review the data linking PVAT to the pathogenesis of CVD in patients with ARDs, focusing on the role of novel PVAT imaging techniques in defining disease risk and responses to biological therapies.

Perivascular Adipose Tissue as an Indication, Contributor to, and Therapeutic Target for Atherosclerosis

Perivascular adipose tissue (PVAT) has been identified to have significant endocrine and paracrine functions, such as releasing bioactive adipokines, cytokines, and chemokines, rather than a non-physiological structural tissue. Considering the contiguity with the vascular wall, PVAT could play a crucial role in the pathogenic microenvironment of atherosclerosis. Growing clinical evidence has shown an association between PVAT and atherosclerosis. Moreover, based on computed tomography, the fat attenuation index of PVAT was verified as an indication of vulnerable atherosclerotic plaques. Under pathological conditions, such as obesity and diabetes, PVAT shows a proatherogenic phenotype by increasing the release of factors that induce endothelial dysfunction and inflammatory cell infiltration, thus contributing to atherosclerosis. Growing animal and human studies have investigated the mechanism of the above process, which has yet to be fully elucidated. Furthermore, traditional treatments for atherosclerosis have been proven to act on PVAT, and we found several studies focused on novel drugs that target PVAT for the prevention of atherosclerosis. Emerging as an indication, contributor to, and therapeutic target for atherosclerosis, PVAT warrants further investigation.

Emerging measurements of atherosclerosis: extra-media thickness, epicardial adipose tissue, and periarterial adipose tissue intima media adventitia index in morbidly obese patients undergoing bariatric surgery

Introduction

Increased values of emerging fat indices are correlated with increased cardiovascular risk.

Aim

To examine the novel non-invasive predictors of coronary disease, namely the carotid extra-media thickness (EMT), PATIMA, and epicardial adipose tissue (EAT), in a group of patients with morbid obesity.

Material and methods

We examined a group of 40 morbidly obese (OB) patients and a control group (CG). All patients were subjected to anthropometric measurements, as well as laboratory and ultrasound examinations.

Results

EATmean and EMTmean differed significantly between groups (OB vs. CG): 5.09 vs. 3.50 and 808.50 vs. 737.00, p < 0.0001, respectively.

Conclusions

Strong correlations were found between novel non-invasive predictors of coronary disease, namely the carotid extra-media thickness, PATIMA, and epicardial adipose tissue. The above-mentioned fat indices were not found to correlate significantly with BMI or other body weight-related parameters used to assess the adipose tissue content. Further studies are required.

Obesity, visceral adiposity and carotid atherosclerosis

Carotid artery atherosclerosis is a complex and multifactorial chronic disease. Our aim was to assess the associations between obesity, fat depots and carotid artery stenosis (CAS) in patients with high cardiovascular (CV) risk.

METHODS

The study group included 391 patients (F/M: 136/255 pts.; age: 61.8 ± 8 years) scheduled for elective coronary angiography. A comprehensive clinical assessment included a carotid artery and abdominal ultrasound involving the following fat depots: (1) carotid extra-media thickness (EMT) indexed to the body mass index (perivascular adipose tissue [PVAT]), and (2) abdominal visceral and subcutaneous fat.

RESULTS

Patients with a ≥50% stenosis of internal carotid artery (ICA) were older (65.9 ± 7 vs 60.3 ± 7 years, p < 0.0001) and had increased PVAT (836 ± 120 vs 779 ± 127 μm, p < 0.01) compared to individuals with <50% internal carotid artery stenosis. None of the CAS parameters were associated with any measures of obesity. Multivariable regression model showed that age (p < 0.0001), PVAT (p < 0.0001) and smoking (p = 0.04) were independently associated with the severity of ICA stenosis.

CONCLUSIONS

Our study showed that carotid extra-media thickness, an index measure of PVAT, is associated with CAS severity. It is a strong and independent predictor of significant ICA stenosis. None of the obesity measurements revealed associations with carotid atherosclerosis.