Original Investigation
Pericardial Fat and the Risk of Heart Failure

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Abstract

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.

Key Words

adipose tissue
adiposity
heart failure
obesity
pericardial fat

Abbreviations and Acronyms

BMI
body mass index
CI
confidence interval
CT
computed tomography
HF
heart failure
HFmrEF
heart failure with mid-range ejection fraction
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
HFuEF
heart failure with unknown ejection fraction
LVEF
left ventricular ejection fraction
PFV
pericardial fat volume

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The views expressed in this manuscript are those of the authors and do not necessarily represent the official views of the NHLBI, the NIH, or the U.S. Department of Health and Human Services. Andreas Kalogeropoulos, MD, MPH, PhD, served as Guest Associate Editor for this paper. Javed Butler, MD, MPH, MBA, served as Guest Editor-in-Chief for this paper.

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