Preventive Cardiology
Relation of Pericardial Fat, Intrathoracic Fat, and Abdominal Visceral Fat With Incident Atrial Fibrillation (from the Framingham Heart Study)

https://doi.org/10.1016/j.amjcard.2016.08.011Get rights and content

Obesity is associated with increased risk of developing atrial fibrillation (AF). Different fat depots may have differential associations with cardiac pathology. We examined the longitudinal associations between pericardial, intrathoracic, and visceral fat with incident AF. We studied Framingham Heart Study Offspring and Third-Generation Cohorts who participated in the multidetector computed tomography substudy examination 1. We constructed multivariable-adjusted Cox proportional hazard models for risk of incident AF. Body mass index was included in the multivariable-adjusted model as a secondary adjustment. We included 2,135 participants (53.3% women; mean age 58.8 years). During a median follow-up of 9.7 years, we identified 162 cases of incident AF. Across the increasing tertiles of pericardial fat volume, age- and gender-adjusted incident AF rate per 1,000 person-years of follow-up were 8.4, 7.5, and 10.2. Based on an age- and gender-adjusted model, greater pericardial fat (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.03 to 1.34) and intrathoracic fat (HR 1.24, 95% CI 1.06 to 1.45) were associated with an increased risk of incident AF. The HRs (95% CI) for incident AF were 1.13 (0.99 to 1.30) for pericardial fat, 1.19 (1.01 to 1.40) for intrathoracic fat, and 1.09 (0.93 to 1.28) for abdominal visceral fat after multivariable adjustment. After additional adjustment of body mass index, none of the associations remained significant (all p >0.05). Our findings suggest that cardiac ectopic fat depots may share common risk factors with AF, which may have led to a lack of independence in the association between pericardial fat with incident AF.

Section snippets

Methods

Our study drew participants from the Offspring Cohort seventh examination (1998 to 2001) and Third-Generation Cohort first examination (2002 to 2005) who additionally participated in the first examination of the multidetector computed tomography (MDCT) substudy from 2002 to 2005.2 The inclusion criteria for the MDCT substudy were: (1) subjects residing in New England at the time of the examination; (2) women ≥40 years and not pregnant and men ≥35 years; and (3) <160 kg body weight due to the

Results

Table 1 describes the demographic and clinical characteristics of the study participants. During a median follow-up of 9.7 years (25th to 75th percentile 8.8 to 10.5 years), 162 cases of incident AF were identified among the 2,135 participants (7.6%). For those with incident AF, the median age of AF diagnosis was 73.4 years (25th to 75th percentile 65.2 to 79.9 years). Baseline characteristics of the participants with incident AF are shown in Supplementary Table 2. The ectopic fat measurements

Discussion

We examined the relation of ectopic adipose tissue depots with incident AF during a median follow-up of 9.7 years. Our findings are threefold. First, pericardial and intrathoracic fat depots were longitudinally associated with incident AF based on the model adjusted for age and gender. Second, after further accounting for risk factor determinants of AF and generalized adiposity, none of the ectopic fat depots were associated with incident AF. Third, abdominal visceral fat was not associated

Disclosures

On December 14, 2015, Dr. Fox has become an employee of Merck and Co, Inc. On February 22, 2016, Dr. Yin has become an employee of Celldex Therapeutics. The other authors have no conflicts of interest to disclose.

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    This work was supported by the National Heart, Lung and Blood Institute’s Framingham Heart Study (Framingham, Massachusetts) (contract N01-HC-25195). Dr. Emelia Benjamin is supported by grants HHSN268201500001I, 2R01HL092577, 1R01 HL128914, 1R01 HL102214, 1RC1HL101056 from the National Institutes of Health.

    NHLBI disclaimer: The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; National Institutes of Health; or the US Department of Health and Human Services.

    See page 1491 for disclosure information.

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