Background: Intima-media thickness (IMT) has been proposed as a measurement of subclinical atherosclerosis and has been associated with cardiovascular disease (CVD). Epicardial adipose tissue (EAT) is a fat depot between the pericardium and myocardium and has been associated with coronary atherosclerosis. The relationship between IMT and EAT thickness has not been reported before. We investigated the relationship between EAT thickness, IMT, CVD risk factors, and ideal cardiovascular health (CVH) metrics using subjects from the Kardiovize Brno 2030 cohort study, a random urban sample population in Central Europe. Methods: We studied 102 individuals (65 males) aged 25⁻64 years (median = 37 years) with no current or past CVD history. We measured IMT using a vascular ultrasound and EAT thickness using transthoracic echocardiography, and collected data on anthropometric factors, CVD risk factors, and CVH score. Correlation tests and multiple linear regression models were applied. Results: In the age- and gender-adjusted model, we demonstrated that, among CVD risk factors, only BMI was significantly and positively associated with EAT thickness (β = 0.182, SE = 0.082, p = 0.030), while no significant associations with IMT were evident. Although both EAT thickness and IMT were negatively correlated with CVH score (r = −0.45, p < 0.001, and r = −0.38, p < 0.001, respectively), we demonstrated that overall CVH score (β = −0.262; SE = 0.077; p = 0.001), as well as BMI (β = −1.305; SE = 0.194; p < 0.001) and blood pressure CVH metrics (β = −0.607; SE = 0.206; p = 0.004) were significantly associated with EAT thickness but not with IMT. Conclusions: Our study is important as it demonstrated for the first time that CVH is associated with EAT thickness. Interestingly, this relationship seems to be dependent on BMI and blood pressure rather than on the other CVH metrics. However, outcome-driven studies are required to confirm these findings.

Department of Internal Medicine ⁻ Cardioangiology Faculty of Medicine Masaryk University Brno 65691 Czech Republic

Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia University of Catania 95123 Catania Italy

Division of Medicine University College London London NW3 2PF UK

Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic Rochester MN 55905 USA

International Clinical Research Center St'Anne University Hospital Brno 60200 Czech Republic

Zobrazit více v PubMed

Lloyd-Jones D.M., Hong Y., Labarthe D., Mozaffarian D., Appel L.J., Van Horn L., Greenlund K., Daniels S., Nichol G., Tomaselli G.F., et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586–613. doi: 10.1161/CIRCULATIONAHA.109.192703. PubMed DOI

Stefan N., Schick F., Haring H.U. Causes, Characteristics, and Consequences of Metabolically Unhealthy Normal Weight in Humans. Cell Metab. 2017;26:292–300. doi: 10.1016/j.cmet.2017.07.008. PubMed DOI

Maffetone P.B., Rivera-Dominguez I., Laursen P.B. Overfat Adults and Children in Developed Countries: The Public Health Importance of Identifying Excess Body Fat. Front. Public Health. 2017;5:190. doi: 10.3389/fpubh.2017.00190. PubMed DOI PMC

Canoy D., Boekholdt S.M., Wareham N., Luben R., Welch A., Bingham S., Buchan I., Day N., Khaw K.T. Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: A population-based prospective study. Circulation. 2007;116:2933–2943. doi: 10.1161/CIRCULATIONAHA.106.673756. PubMed DOI

Britton K.A., Fox C.S. Ectopic fat depots and cardiovascular disease. Circulation. 2011;124:e837–e841. doi: 10.1161/CIRCULATIONAHA.111.077602. PubMed DOI

Iacobellis G. Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat. Rev. Endocrinol. 2015;11:363–371. doi: 10.1038/nrendo.2015.58. PubMed DOI

Wu Y., Zhang A., Hamilton D.J., Deng T. Epicardial Fat in the Maintenance of Cardiovascular Health. Methodist DeBakey Cardiovasc. J. 2017;13:20–24. doi: 10.14797/mdcj-13-1-20. PubMed DOI PMC

De Matthaeis A., Greco A., Dagostino M.P., Paroni G., Fontana A., Vinciguerra M., Mazzoccoli G., Seripa D., Vendemiale G. Effects of hypercapnia on peripheral vascular reactivity in elderly patients with acute exacerbation of chronic obstructive pulmonary disease. Clin. Interv. Aging. 2014;9:871–878. PubMed PMC

Plichart M., Celermajer D.S., Zureik M., Helmer C., Jouven X., Ritchie K., Tzourio C., Ducimetiere P., Empana J.P. Carotid intima-media thickness in plaque-free site, carotid plaques and coronary heart disease risk prediction in older adults. The Three-City Study. Atherosclerosis. 2011;219:917–924. doi: 10.1016/j.atherosclerosis.2011.09.024. PubMed DOI

Polonsky T.S., Ning H., Daviglus M.L., Liu K., Burke G.L., Cushman M., Eng J., Folsom A.R., Lutsey P.L., Nettleton J.A., et al. Association of Cardiovascular Health With Subclinical Disease and Incident Events: The Multi-Ethnic Study of Atherosclerosis. J. Am. Heart Assoc. 2017;6:e004894. doi: 10.1161/JAHA.116.004894. PubMed DOI PMC

Abubakar I.I., Tillmann T., Banerjee A. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: A systematic analysis for the Global Burden of Disease Study. Lancet. 2015;385:117–171. PubMed PMC

Fuster V., Kelly B.B., Vedanthan R. Global cardiovascular health: Urgent need for an intersectoral approach. J. Am. Coll. Cardiol. 2011;58:1208–1210. doi: 10.1016/j.jacc.2011.05.038. PubMed DOI

Movsisyan N.K., Vinciguerra M., Lopez-Jimenez F., Kunzova S., Homolka M., Jaresova J., Cifkova R., Sochor O. Kardiovize Brno 2030, a prospective cardiovascular health study in Central Europe: Methods, baseline findings and future directions. Eur. J. Prev. Cardiol. 2018;25:54–64. doi: 10.1177/2047487317726623. PubMed DOI

Harris P.A., Taylor R., Thielke R., Payne J., Gonzalez N., Conde J.G. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 2009;42:377–381. doi: 10.1016/j.jbi.2008.08.010. PubMed DOI PMC

Folsom A.R., Yatsuya H., Nettleton J.A., Lutsey P.L., Cushman M., Rosamond W.D., Investigators A.S. Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J. Am. Coll. Cardiol. 2011;57:1690–1696. doi: 10.1016/j.jacc.2010.11.041. PubMed DOI PMC

Iacobellis G., Assael F., Ribaudo M.C., Zappaterreno A., Alessi G., Di Mario U., Leonetti F. Epicardial fat from echocardiography: A new method for visceral adipose tissue prediction. Obes. Res. 2003;11:304–310. doi: 10.1038/oby.2003.45. PubMed DOI

Iacobellis G., Willens H.J. Echocardiographic epicardial fat: A review of research and clinical applications. J. Am. Soc. Echocardiogr. Off. Publ. Am. Soc. Echocardiogr. 2009;22:1311–1319. doi: 10.1016/j.echo.2009.10.013. PubMed DOI

Iacobellis G., Ribaudo M.C., Assael F., Vecci E., Tiberti C., Zappaterreno A., Di Mario U., Leonetti F. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: A new indicator of cardiovascular risk. J. Clin. Endocrinol. Metab. 2003;88:5163–5168. doi: 10.1210/jc.2003-030698. PubMed DOI

Stein J.H., Korcarz C.E., Hurst R.T., Lonn E., Kendall C.B., Mohler E.R., Najjar S.S., Rembold C.M., Post W.S. American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: A consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force Endorsed by the Society for Vascular Medicine. J. Am. Soc. Echocardiogr. Off. Publ. Am. Soc. Echocardiogr. 2008;21:93–111. PubMed

Nambi V., Chambless L., Folsom A.R., He M., Hu Y., Mosley T., Volcik K., Boerwinkle E., Ballantyne C.M. Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: The ARIC (Atherosclerosis Risk In Communities) study. J. Am. Coll. Cardiol. 2010;55:1600–1607. doi: 10.1016/j.jacc.2009.11.075. PubMed DOI PMC

Devynck M.A., Simon A., Pernollet M.G., Chironi G., Gariepy J., Rendu F., Levenson J. Plasma cGMP and large artery remodeling in asymptomatic men. Hypertension. 2004;44:919–923. doi: 10.1161/01.HYP.0000145862.33770.e9. PubMed DOI

Juonala M., Kahonen M., Laitinen T., Hutri-Kahonen N., Jokinen E., Taittonen L., Pietikainen M., Helenius H., Viikari J.S., Raitakari O.T. Effect of age and sex on carotid intima-media thickness, elasticity and brachial endothelial function in healthy adults: The cardiovascular risk in Young Finns Study. Eur. Heart J. 2008;29:1198–1206. doi: 10.1093/eurheartj/ehm556. PubMed DOI

Alexopoulos N., McLean D.S., Janik M., Arepalli C.D., Stillman A.E., Raggi P. Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis. 2010;210:150–154. doi: 10.1016/j.atherosclerosis.2009.11.020. PubMed DOI

Rosito G.A., Massaro J.M., Hoffmann U., Ruberg F.L., Mahabadi A.A., Vasan R.S., O’Donnell C.J., Fox C.S. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: The Framingham Heart Study. Circulation. 2008;117:605–613. doi: 10.1161/CIRCULATIONAHA.107.743062. PubMed DOI

Mahabadi A.A., Massaro J.M., Rosito G.A., Levy D., Murabito J.M., Wolf P.A., O’Donnell C.J., Fox C.S., Hoffmann U. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: The Framingham Heart Study. Eur. Heart J. 2009;30:850–856. doi: 10.1093/eurheartj/ehn573. PubMed DOI PMC

Eroglu S., Sade L.E., Yildirir A., Bal U., Ozbicer S., Ozgul A.S., Bozbas H., Aydinalp A., Muderrisoglu H. Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. Nutr. Metab. Cardiovasc. Dis. NMCD. 2009;19:211–217. doi: 10.1016/j.numecd.2008.05.002. PubMed DOI

Iacobellis G., Barbaro G., Gerstein H.C. Relationship of epicardial fat thickness and fasting glucose. Int. J. Cardiol. 2008;128:424–426. doi: 10.1016/j.ijcard.2007.12.072. PubMed DOI

Iacobellis G., Gao Y.J., Sharma A.M. Do cardiac and perivascular adipose tissue play a role in atherosclerosis? Curr. Diabetes Rep. 2008;8:20–24. doi: 10.1007/s11892-008-0005-2. PubMed DOI

Lorenz M.W., Markus H.S., Bots M.L., Rosvall M., Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: A systematic review and meta-analysis. Circulation. 2007;115:459–467. doi: 10.1161/CIRCULATIONAHA.106.628875. PubMed DOI

Iacobellis G., Sharma A.M., Pellicelli A.M., Grisorio B., Barbarini G., Barbaro G. Epicardial adipose tissue is related to carotid intima-media thickness and visceral adiposity in HIV-infected patients with highly active antiretroviral therapy-associated metabolic syndrome. Curr. HIV Res. 2007;5:275–279. doi: 10.2174/157016207780077084. PubMed DOI

Iacobellis G., Willens H.J., Barbaro G., Sharma A.M. Threshold values of high-risk echocardiographic epicardial fat thickness. Obesity. 2008;16:887–892. doi: 10.1038/oby.2008.6. PubMed DOI

Machann J., Thamer C., Schnoedt B., Haap M., Haring H.U., Claussen C.D., Stumvoll M., Fritsche A., Schick F. Standardized assessment of whole body adipose tissue topography by MRI. J. Magn. Reson. Imaging. 2005;21:455–462. doi: 10.1002/jmri.20292. PubMed DOI

Rabkin S.W. The relationship between epicardial fat and indices of obesity and the metabolic syndrome: A systematic review and meta-analysis. Metab. Syndr. Relat. Disord. 2014;12:31–42. doi: 10.1089/met.2013.0107. PubMed DOI

Rabkin S.W., Campbell H. Comparison of reducing epicardial fat by exercise, diet or bariatric surgery weight loss strategies: A systematic review and meta-analysis. Obes. Rev. Off. J. Int. Assoc. Study Obes. 2015;16:406–415. doi: 10.1111/obr.12270. PubMed DOI

Munoz M.J.F., Acevedo L.B., Perez N.C., Martinez A.L.V., Gutierrez N.T., Garcia S.V., Cruz A.R., Martinez A.D., Garcia R.S., Trevino A.Z., et al. Epicardial adipose tissue is associated with visceral fat, metabolic syndrome, and insulin resistance in menopausal women. Rev. Esp. Cardiol. 2014;67:436–441. PubMed

Ye Z., Lu H., Su Q., Li L. Association between body mass index (BMI) and carotid intima media thickness in patients with type 2 diabetes mellitus: Results from the PROLOGUE study. Oncotarget. 2018;9:s508–s523. doi: 10.18632/oncotarget.24000. DOI

Kulshreshtha A., Goyal A., Veledar E., McClellan W., Judd S., Eufinger S.C., Bremner J.D., Goldberg J., Vaccarino V. Association between ideal cardiovascular health and carotid intima-media thickness: A twin study. J. Am. Heart Assoc. 2014;3:e000282. doi: 10.1161/JAHA.113.000282. PubMed DOI PMC

Lipidomic Profiling Identifies Signatures of Poor Cardiovascular Health

Prevalence of adiposity-based chronic disease in middle-aged adults from Czech Republic: The Kardiovize study

Is Drinking Alcohol Really Linked to Cardiovascular Health? Evidence from the Kardiovize 2030 Project

Determinants of Metabolic Health Across Body Mass Index Categories in Central Europe: A Comparison Between Swiss and Czech Populations

How dietary patterns affect left ventricular structure, function and remodelling: evidence from the Kardiovize Brno 2030 study

Dog Ownership and Cardiovascular Health: Results From the Kardiovize 2030 Project

Independent Effects of Hypertension and Obesity on Left Ventricular Mass and Geometry: Evidence from the Cardiovision 2030 Study

Sleep Duration and Excessive Daytime Sleepiness Are Associated with Obesity Independent of Diet and Physical Activity

Association of Dietary Patterns with Metabolic Syndrome: Results from the Kardiovize Brno 2030 Study