title: Association of epicardial adipose tissue with cardiometabolic risk and metabolic syndrome in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  Patients with rheumatoid arthritis (RA) have increased coronary atherosclerosis possibly related to increased prevalence of visceral adiposity, insulin resistance, and metabolic syndrome. Epicardial adipose tissue (EAT), a type of visceral fat, may contribute to cardiometabolic risk. The aim of this study was to measure EAT volume in patients with RA and determine its relationship with cardiometabolic risk markers and coronary artery calcium.
  
  
  METHODS
  EAT volume and coronary artery calcium score were measured by noncontrast cardiac computed tomography and compared in RA patients (n = 162) and controls (n = 89). The relationships between EAT volume and markers of cardiometabolic risk in RA were examined with adjustment for age, race, and sex.
  
  
  RESULTS
  Among RA patients, EAT volume was positively associated with interleukin-6 (P = 0.03), triglycerides (P = 0.004), hypertension (P = 0.01), homeostatic model of insulin resistance (HOMA) (P < 0.001), smoking history (P = 0.04), and homocysteine level (P = 0.001), and negatively associated with high-density lipoprotein (P = 0.005). With further adjustment for waist circumference (a measure of visceral obesity), EAT volume remained independently associated with triglycerides, HOMA, current smoking, and homocysteine level (all P < 0.05). EAT volume was not associated with corticosteroid use or coronary artery calcium score. Patients with metabolic syndrome had significantly greater EAT volume (P < 0.001) and each increase in metabolic syndrome criteria was associated, on average, with a 20% increase (95% confidence interval 14-26%) in EAT volume (P < 0.001).
  
  
  CONCLUSIONS
  EAT volume is associated with metabolic syndrome and cardiometabolic risk factors, including insulin resistance, triglycerides, current smoking, and homocysteine levels, but not with coronary artery calcium in RA patients.
authors.affiliation: Vanderbilt University, Nashville, Tennessee.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Ormseth
authors.forename: Aliza
authors.initials: A
authors.lastname: Lipson
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Alexopoulos
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Hartlage
authors.forename: Annette M
authors.initials: AM
authors.lastname: Oeser
authors.forename: Aihua
authors.initials: A
authors.lastname: Bian
authors.forename: Tebeb
authors.initials: T
authors.lastname: Gebretsadik
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
authors.forename: C Michael
authors.initials: CM
authors.lastname: Stein
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism*; D050218:Body Fat Distribution / Q000379:methods; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000378:metabolism / Q000473:pathology*; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism*; D008875:Middle Aged; D010496:Pericardium / Q000378:metabolism / Q000473:pathology*; D012307:Risk Factors