title: Obesity, ultrasound indexes of fat depots and lipid goal attainment in patients with high and very high cardiovascular risk: A novel approach towards better risk reduction.
abstract: OBJECTIVE
  Our aim was to assess the attainment of primary (low density lipoprotein cholesterol; LDL-C) and secondary (non-high density lipoprotein cholesterol; non-HDL-C) lipid therapeutic goals in relation to obesity, clinical measures of adiposity and ultrasound indexes of fat depots, including the novel index of periarterial adipose tissue (PAT): carotid artery extra media thickness (EMT).
  
  
  RESULTS
  High and very high cardiovascular (CV) risk patients (n = 420; F/M: 34/66%; age: 61.2 ± 7 years) with prior statin treatment (≥ 18 months) were enrolled into this cross-sectional study. All patients had a detailed assessment with several anthropometric measures and ultrasound indexes of fat depots indexed to BMI: abdominal (Intra-abdominal Fat Thickness; IAT and Pre-peritoneal Fat Thickness; PreFT), paracardial (Epicardial Fat Thickness; EFT and Pericardial Fat Thickness; PFT) and the new index corresponding to PAT (carotid EMT). Lipid goals attainment in the study group was as follows: 34% (LDL-C goal), 39% (non-HDL-C goal) and 35% (both LDL and non-HDL-C goals). Among ultrasound indexes, patients with both lipid goals attainment revealed significantly lower carotid EMT/BMI (LDL-C goal: 25.2 ± 4.2 vs 27.5 ± 4.1, p < 0.01 and non-HDL-C goal: 26.1 ± 4 vs 27.7 ± 4.2, p < 0.01) and IAT/BMI (LDL-C goal: 2.35 ± 0.66 vs 2.51 ± 0.71, p = 0.02 and non-HDL-C goal: p = ns) compared to individuals without goals achievement. Moreover, lipid goals attainment was associated with both measures: carotid EMT/BMI (LDL-C goal: r = -0.2, p < 0.05 and non-HDL-C goal: r = -0.2, p < 0.05) and IAT/BMI (LDL-C goal: r = -0.2, p < 0.05 and non-HDL-C goal: r = -0.2, p < 0.05). Multivariable regression analysis showed also independent association between carotid EMT/BMI and both goals achievement: LDL-C (p = 0.01) and non-HDL-C goal (p = 0.01). Other fat depots indexes (EFT, PFT and PreFT) failed to provide additional data.
  
  
  CONCLUSIONS
  Contrary to overall obesity and most clinical measures of adiposity, carotid EMT and abdominal IAT, but not other ultrasound indexes of fat depots revealed associations independent from BMI with lipid goal attainment and may help identify patients requiring more aggressive lipid management.
authors.affiliation: School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland. Electronic address: mhaberka@op.pl.
authors.forename: M
authors.initials: M
authors.lastname: Haberka
authors.affiliation: School of Medicine, Medical University of Silesia, Department of Internal Medicine and Clinical Pharmacology, Katowice, Poland.
authors.forename: B
authors.initials: B
authors.lastname: Okopień
authors.affiliation: School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland.
authors.forename: Z
authors.initials: Z
authors.lastname: Gąsior
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000378:metabolism; D050154:Adiposity; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D059168:Carotid Intima-Media Thickness; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Extra-media thickness; Fat depots; Lipid goal; Obesity; Statin