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Pericardial Fat and the Risk of Heart Failure
Satish Kenchaiah1, Jingzhong Ding2, J Jeffrey Carr3
1Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, Maryland, USA.
Insights
Pericardial fat volume (PFV) is linked to increased heart failure (HF) risk, especially HF with preserved ejection fraction. This association is significant in both women and men across diverse ethnic groups.
Area of Science:
- Cardiology
- Cardiovascular Disease Research
- Obesity and Health
Background:
- Obesity is a known risk factor for heart failure (HF).
- The specific impact of pericardial fat on the incidence of HF remains unclear.
- Understanding this relationship is crucial for cardiovascular risk assessment.
Purpose of the Study:
- To investigate the association between pericardial fat volume (PFV) and the development of newly diagnosed heart failure (HF).
- To explore potential sex differences in this association.
Main Methods:
- Utilized cardiac computed tomography to measure PFV in 6,785 participants from the Multi-Ethnic Study of Atherosclerosis (MESA).
- Employed Cox proportional hazards regression to analyze PFV as a continuous and dichotomous variable.
- Adjusted for various factors including anthropometrics, abdominal fat, inflammation, and hemodynamic stress markers.
Main Results:
- Over 90,686 person-years, 385 participants developed incident HF.
- Increased PFV was associated with a higher risk of HF in both women and men, with a stronger effect observed in women.
- Elevated PFV was predominantly linked to an increased risk of HF with preserved ejection fraction.
Conclusions:
- Pericardial fat volume is an independent predictor of incident heart failure.
- The association between PFV and HF risk is significant in both sexes and across diverse ethnicities.
- PFV is particularly associated with HF with preserved ejection fraction.
Background:
Obesity is a well-established risk factor for heart failure (HF). However, implications of pericardial fat on incident HF is unclear.
Objectives:
This study sought to examine the association between pericardial fat volume (PFV) and newly diagnosed HF.
Methods:
This study ascertained PFV using cardiac computed tomography in 6,785 participants (3,584 women and 3,201 men) without pre-existing cardiovascular disease from the MESA (Multi-Ethnic Study of Atherosclerosis). Cox proportional hazards regression was used to evaluate PFV as continuous and dichotomous variable, maximizing the J-statistic: (Sensitivity + Specificity - 1).
Results:
In 90,686 person-years (median: 15.7 years; interquartile range: 11.7 to 16.5 years), 385 participants (5.7%; 164 women and 221 men) developed newly diagnosed HF. PFV was lower in women than in men (69 ± 33 cm3 vs. 92 ± 47 cm3; p < 0.001). In multivariable analyses, every 1-SD (42 cm3) increase in PFV was associated with a higher risk of HF in women (hazard ratio [HR]: 1.44; 95% confidence interval [CI]: 1.21 to 1.71; p < 0.001) than in men (HR: 1.13; 95% CI: 1.01 to 1.27; p = 0.03) (interaction p = 0.01). High PFV (≥70 cm3 in women; ≥120 cm3 in men) conferred a 2-fold greater risk of HF in women (HR: 2.06; 95% CI: 1.48 to 2.87; p < 0.001) and a 53% higher risk in men (HR: 1.53; 95% CI: 1.13 to 2.07; p = 0.006). In sex-stratified analyses, greater risk of HF remained robust with additional adjustment for anthropometric indicators of obesity (p ≤ 0.008), abdominal subcutaneous or visceral fat (p ≤ 0.03) or biomarkers of inflammation and hemodynamic stress (p < 0.001) and was similar among Whites, Blacks, Hispanics, and Chinese (interaction p = 0.24). Elevated PFV predominantly augmented the risk of HF with preserved ejection fraction (p < 0.001) rather than reduced ejection fraction (p = 0.31).
Conclusions:
In this large, community-based, ethnically diverse, prospective cohort study, pericardial fat was associated with an increased risk of HF, particularly HF with preserved ejection fraction, in women and men.
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