title: Epicardial adipose tissue is an independent marker of cardiovascular risk in HIV-infected patients.
abstract: BACKGROUND
  Epicardial adipose tissue (EAT) is increased in HIV-infected patients. The aim of this study was to evaluate the association between EAT and coronary artery calcium (CAC) a marker of atherosclerosis; furthermore, we investigated the association of EAT with HIV infection, antiretroviral therapy (ART), and lipodystrophy.
  
  
  METHODS
  This was a cross-sectional study of 876 consecutive HIV-infected ART experienced patients. Patients underwent CAC imaging with multidetector computed tomography (CT) for atherosclerosis screening and risk of cardiovascular events (CAC score >100); EAT was measured in the same CT images. Factors independently associated with EAT were explored in a multivariable backward stepwise linear regression analysis. Multivariable logistic regression was used to evaluate the association of EAT and CAC score greater than 100.
  
  
  RESULTS
  Patients' mean age was 47.2 ± 8 years, 68% were men. EAT was associated with central fat accumulation and mixed lipodystrophy phenotypes. Factors independently associated with EAT were: age [β = 0.6, confidence interval (CI) 0.2-1.0], male sex (β = 6.6, CI 0.5-12.7), visceral adipose tissue (β = 0.12, CI 0.08-0.17), waist circumference (β = 0.7, CI 0.04-1.3), current CD4⁺ (β = 0.6, CI 0.1-1.2, per 50 cells), total cholesterol (β = 0.1, CI 0.02-0.15), and cumulative exposure to ART (months) (β = 0.05, CI 0.00-0.11). EAT (per 10 cm³) was associated with CAC greater than 100 (odds ratio = 1.10, CI 1.02-1.19) after adjustment for age, male sex, and diabetes.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Metabolic Clinic, Infectious and Tropical Diseases Unit, Department of Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Scaglioni
authors.forename: Stefano
authors.initials: S
authors.lastname: Zona
authors.forename: Gabriella
authors.initials: G
authors.lastname: Orlando
authors.forename: Federica
authors.initials: F
authors.lastname: Carli
authors.forename: Guido
authors.initials: G
authors.lastname: Ligabue
authors.forename: Giulia
authors.initials: G
authors.lastname: Besutti
authors.forename: Pietro
authors.initials: P
authors.lastname: Bagni
authors.forename: Rosario
authors.initials: R
authors.lastname: Rossi
authors.forename: Maria G
authors.initials: MG
authors.lastname: Modena
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000473:pathology* / Q000821:virology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D002118:Calcium / Q000032:analysis; D002318:Cardiovascular Diseases / Q000150:complications*; D003324:Coronary Artery Disease / Q000150:complications; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000821:virology; D039682:HIV-Associated Lipodystrophy Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000473:pathology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers; D002118:Calcium