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(Circulation. 2008;117:605-613.)
© 2008 American Heart Association, Inc.

Epidemiology

Pericardial Fat, Visceral Abdominal Fat, Cardiovascular Disease Risk Factors, and Vascular Calcification in a Community-Based Sample

The Framingham Heart Study

Guido A. Rosito, MD; Joseph M. Massaro, PhD; Udo Hoffmann, MD, MPH; Frederick L. Ruberg, MD; Amir A. Mahabadi, BS; Ramachandran S. Vasan, MD; Christopher J. O’Donnell, MD, MPH; Caroline S. Fox, MD, MPH

From the Cardiac MR CT PET Program, Department of Radiology (G.A.R., U.H., A.A.M.), and the Cardiology Division (C.J.O.), Massachusetts General Hospital, Harvard Medical School, Boston; Federal Foundation School of Medical Sciences of Porto Alegre (G.A.R.), Porto Alegre, Rio Grande do Sul, Brazil; Boston University Department of Mathematics (J.M.M.), Boston, Mass; Department of Cardiology, Boston Medical Center (F.L.R., R.S.V.), Boston, Mass; Framingham Heart Study of the National Heart, Lung, and Blood Institute (C.J.O., C.S.F.), Framingham, Mass; and Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (C.S.F.), Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Caroline S. Fox, MD, MPH, NHLBI’s Framingham Heart Study, 73 Mt Wayte Ave, Suite 2, Framingham, MA 01702. E-mail foxca{at}nhlbi.nih.gov

Received September 28, 2007; accepted November 20, 2007.

Background— Pericardial fat may be an important mediator of metabolic risk. Correlations with cardiovascular disease risk factors and vascular calcification in a community-based sample are lacking. We sought to examine associations between pericardial fat, metabolic risk factors, and vascular calcification.

Methods and Results— Participants free of cardiovascular disease from the Framingham Heart Study (n=1155, mean age 63 years, 54.8% women) who were part of a multidetector computed tomography study underwent quantification of intrathoracic fat, pericardial fat, visceral abdominal fat (VAT), coronary artery calcification, and aortic artery calcification. Intrathoracic and pericardial fat volumes were examined in relation to body mass index, waist circumference, VAT, metabolic risk factors, coronary artery calcification, and abdominal aortic calcification. Intrathoracic and pericardial fat were directly correlated with body mass index (r=0.41 to 0.51, P<0.001), waist circumference (r=0.43 to 0.53, P<0.001), and VAT (r=0.62 to 0.76, P<0.001). Both intrathoracic and pericardial fat were associated with higher triglycerides (P<0.0001), lower high-density lipoprotein (P<0.0001), hypertension (P<0.0001 to 0.01), impaired fasting glucose (P<0.0001 to 0.001), diabetes mellitus (P=0.0005 to 0.009), and metabolic syndrome (P<0.0001) after multivariable adjustment. Associations generally persisted after additional adjustment for body mass index and waist circumference but not after adjustment for VAT (all P>0.05). Pericardial fat, but not intrathoracic fat, was associated with coronary artery calcification after multivariable and VAT adjustment (odds ratio 1.21, 95% confidence interval 1.005 to 1.46, P=0.04), whereas intrathoracic fat, but not pericardial fat, was associated with abdominal aortic calcification (odds ratio 1.32, 95% confidence interval 1.03 to 1.67, P=0.03).

Conclusions— Pericardial fat is correlated with multiple measures of adiposity and cardiovascular disease risk factors, but VAT is a stronger correlate of most metabolic risk factors. However, intrathoracic and pericardial fat are associated with vascular calcification, which suggests that these fat depots may exert local toxic effects on the vasculature.

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