title: Epicardial fat thickness: distribution and association with diabetes mellitus, hypertension and the metabolic syndrome in the ELSA-Brasil study.
abstract: Epicardial fat thickness (EFT) has emerged as a marker of cardiometabolic risk, but its clinical use warrants proper knowledge of its distribution and associations in populations. We aimed to describe the distribution of EFT, its demographic correlates and independent associations with diabetes, hypertension and metabolic syndrome (MS) in free-living Brazilian adults. From the baseline echocardiography of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)-a cohort study of civil servants aged 35-74 years-EFT was measured from a randomly selected sample of 998 participants as the mean of two paraesternal windows obtained at end systole (EFTsyst) and end diastole (EFTdiast). From the 421 individuals free of diabetes, hypertension and MS, we defined EFT reference values and the EFTsyst 75th percentile cut-off. Median EFTsyst was 1.5 (IQR 0-2.6) mm; a large proportion (84 %) had EFTdiast = 0. EFT was higher in women and lower in blacks, and increased with age and BMI. Although EFT was higher in those with diabetes, hypertension, and MS, EFT associations were reduced when adjusted for age, sex and ethnicity, and were non-significant after adjusting for obesity measures. In conclusion, the amount of EFT in this large multiethnic population is smaller than reported in other populations. EFT reference values varied across demographic and clinical variables, EFT associations with cardiometabolic variables being largely explained by age, sex, ethnicity and central obesity. Although EFT can help identify individuals at increased cardiometabolic risk, it will likely have a limited additional role compared to current risk stratification strategies.
authors.affiliation: Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Daniela Bertol
authors.initials: DB
authors.lastname: Graeff
authors.affiliation: Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. mufoppa@hcpa.edu.br.|Postgraduate Studies Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. mufoppa@hcpa.edu.br.|School of Medicine, Federal University of Rio Grande do Sul, Av. Ramiro Barcelos, 2600 Sala 414, 90035-003, Porto Alegre, RS, Brazil. mufoppa@hcpa.edu.br.
authors.forename: Murilo
authors.initials: M
authors.lastname: Foppa
authors.affiliation: Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Julio Cesar Gall
authors.initials: JC
authors.lastname: Pires
authors.affiliation: Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Vigo
authors.affiliation: Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Maria Ines
authors.initials: MI
authors.lastname: Schmidt
authors.affiliation: University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Paulo Andrade
authors.initials: PA
authors.lastname: Lotufo
authors.affiliation: Federal University of Espirito Santo, Vitoria, Brazil.
authors.forename: Jose Geraldo
authors.initials: JG
authors.lastname: Mill
authors.affiliation: Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Bruce Bartholow
authors.initials: BB
authors.lastname: Duncan
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000208:ethnology; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000208:ethnology; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000000981:diagnostic imaging* / Q000208:ethnology; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012307:Risk Factors
keywords: Diabetes; Echocardiography; Epicardial fat; Hypertension; Metabolic syndrome