title: Epicardial fat is associated with severity of subclinical coronary atherosclerosis in familial hypercholesterolemia.
abstract: Familial hypercholesterolemia (FH) is a common genetic disorder characterized by elevated blood cholesterol, increased prevalence of subclinical atherosclerosis and high risk of premature coronary heart disease. However, this risk is not explained solely by elevated LDL-cholesterol concentrations, and other factors may influence atherosclerosis development. There is evidence that increased adiposity may predispose to atherosclerosis in FH. Epicardial fat has been associated with subclinical coronary atherosclerosis in the general population. This study evaluated the association of epicardial fat (EFV) volume with the presence and extent of subclinical coronary atherosclerosis detected by computed tomography angiography in FH patients.
  
  
  
  Ninety-seven FH subjects (35% male, mean age 45 ± 13 years, LDL-C 281 ± 56 mg/dL, 67% with proven molecular defects) underwent computed tomography angiography and coronary artery calcium (CAC) scoring. EFV was measured in non-contrast images using a semi-automated method. Segment-stenosis score (SSS) and segment-involvement score (SIS) were calculated. Multivariate Poisson regression was utilized to assess an independent association of EFV with coronary atherosclerotic burden.
  
  
  
  EFV was positively associated with age, body mass index, waist circumference, blood glucose, the presence of the metabolic syndrome components, but not with LDL-C. After adjusting for confounders and abdominal circumference, an independent association (shown as β coefficients and 95% confidence intervals) of EVF with CAC scores [β = 0.263 (0.234; 0.292), p=0.000], SIS [β = 0.304 (0.141; 0.465) p=0.000] and SSS [β = 0.296 (0.121; 0.471), p=0.001] was found.
  
  
  
  In FH, EFV was independently associated with coronary atherosclerotic presence and severity.
authors.affiliation: Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil.
authors.forename: Leonardo C
authors.initials: LC
authors.lastname: Mangili
authors.affiliation: Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil.
authors.forename: Otavio C
authors.initials: OC
authors.lastname: Mangili
authors.affiliation: Center for Clinical and Epidemiological Research and Division of Internal Medicine, University Hospital, University of Sao Paulo, Sao Paulo, SP, Brazil.
authors.forename: Márcio S
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil.
authors.forename: Márcio H
authors.initials: MH
authors.lastname: Miname
authors.affiliation: Center for Clinical and Epidemiological Research and Division of Internal Medicine, University Hospital, University of Sao Paulo, Sao Paulo, SP, Brazil.
authors.forename: Paulo H
authors.initials: PH
authors.lastname: Harada
authors.affiliation: Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil.
authors.forename: Leonardo M
authors.initials: LM
authors.lastname: Lima
authors.affiliation: Cardiovascular MR and CT Sector Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.affiliation: Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil; Preventive Medicine Centre and Cardiology Program Hospital Israelita Albert Einstein, Sao Paulo, Brazil. Electronic address: raul.santos@incor.usp.br.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D050154:Adiposity; D000328:Adult; D050197:Atherosclerosis / Q000097:blood; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010496:Pericardium / Q000473:pathology*; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
chemical_list: D008078:Cholesterol, LDL; D002784:Cholesterol
keywords: Atherosclerosis; Calcium score; Computed tomography; Epicardial fat; Familial hypercholesterolemia; Obesity