title: Relationship of epicardial fat thickness and nonalcoholic fatty liver disease to coronary artery calcification: From the CAESAR study.
abstract: Epicardial fat and nonalcoholic fatty liver disease (NAFLD) are associated with subclinical atherosclerosis; however, the combined effect of both EAT and NAFLD on coronary artery calcium (CAC) is unclear.
  
  
  
  The present study was performed to evaluate the association of both epicardial fat thickness (EFT) and NAFLD with CAC.
  
  
  
  Among 2277 individuals enrolled in the CArdiometabolic risk, Epicardial fat, and Subclinical Atherosclerosis Registry (CAESAR) Study, 1473 individuals (1242 men, mean age, 44 ± 9 years) were included for analysis. Echocardiographic EFT and ultrasonographic fatty liver were measured. Individuals were divided into 4 groups according to EFT and NAFLD (group I: low EFT and without NAFLD; group II: low EFT and with NAFLD; group III: high EFT and without NAFLD; and group IV: high EFT and with NAFLD).
  
  
  
  The median EFT value (interquartiles) was 3.17 mm (2.58 mm, 3.85 mm), and the prevalence of NAFLD and CACS >0 was 46.0% and 16.8%, respectively. The prevalence of CACS >0 was 7.9%, 16.8%, 18.0%, and 26.0% in group I, II, III, and IV, respectively (P < .001). On multivariate regression after adjusting for variables with a univariate relationship (P < .20), group IV had a significantly higher OR for CACS >0, and the OR in group III was marginally significant, compared to group I (1.458 [0.795, 2.672], 1.744 [0.999, 3.046], and 1.864 [1.041, 3.337] for groups II, III, and IV, respectively).
  
  
  
  This study shows that both increased EFT and presence of NAFLD are associated with coronary artery calcification, and that increased EFT is more strongly related to CAC than NAFLD, in spite of NAFLD having greater cardiometabolic risk than EFT.
authors.affiliation: Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: bjjake.kim@samsung.com.
authors.forename: Byung Jin
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Cheong
authors.affiliation: Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jung Gyu
authors.initials: JG
authors.lastname: Kang
authors.affiliation: Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Bum Soo
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Kang
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D002114:Calcinosis / Q000150:complications*; D003331:Coronary Vessels / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology*; D010496:Pericardium / Q000473:pathology*; D056910:Republic of Korea / Q000453:epidemiology
keywords: Coronary artery calcification; Epicardial adipose tissue; Epicardial fat thickness; Fatty liver; Nonalcoholic fatty liver disease