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Epicardial adipose (fat) tissue (EAT) is the true visceral fat depot of the heart that accounts for approximately 20% of total heart weight. Recently, a close relationship between coronary artery disease CAD and EAT has been shown in end stage renal disease patients. The aim of this study was to test the association of EAT with more detailed clinical comorbidities and the novel osteocyte derived protein, sclerostin.
Materıal and Methods
Epicardial fat volume (EFV), coronary artery calcification score (CACS) and arteriovenous fistula (AVF) calcification were evaluated by means of computed tomography as previously described. Moreover, patients underwent B-mode ultrasonography of common carotid artery for estimating carotid artery intima media thickness (CIMT) and the presence of plaques. Serum biochemical parameters, 25-hydroxy vitamin D3 and sclerostin levels were also measured.
Mean EFV was higher compared to healthy controls (155±10 vs 110±30 cm3, p=0.02). EFV correlated with Kt/V urea (r=-0,464, p=0,006), serum albumin (r=-0,355, p=0,039), 25-hydroxy vitamin D3 (r=-0,313, p=0,024) and sclerostin (r=0,331, p=0,017). According to serum 25-hydroxy vitamin D3 quartiles, patients in the lowest quartile (<11 microgr/L) had higher EFV compared to patients with the highest quartile (>30 microgr/L) (170±69 vs 119±53 cm3, p=0,027). No significant differences in EFV among serum sclerostine quartiles were demonstrated.
Moreover, positive correlations between EFV and CACS (r=0,350, p=0,009), CIMT (r=0,387, p=0.003) and AVF calcification (r=0.372, p=0.007) were noted. Patients with angiographically documented peripheral arterial disease had higher EFV compared to ones without disease (165±42 vs 123±39 cm3, p=0.042). Multivariable adjusted regression analysis revealed that presence of diabetes (49% increase compared to non-diabetics, P=0,023) and decreased serum 25-hydroxy vitamin D3 levels were independently associated with increased EFV (21% increase per 1-SD decrease in 25-hydroxy vitamin D3 concentration, P=0,045).
The pathophysiological impact of these close associations found in this work needs further studies.