Relationship of pericardial fat with lipoprotein distribution: The Multi-Ethnic study of atherosclerosis


      • Pericardial fat may be related to atherogenic lipoprotein abnormalities.
      • We analysed data from the Multi-Ethnic Study of Atherosclerosis.
      • Pericardial fat was associated with higher level of VLDL-P and smaller HDL-P.
      • Lipoprotein profile does not modify association of pericardial fat with CVD risk.



      Pericardial fat and lipoprotein abnormalities contribute to increased risk of cardiovascular disease (CVD). We investigated the relationship between pericardial fat volume and lipoprotein distribution, and whether the association of pericardial fat volume with subclinical atherosclerosis and incident CVD events differs according to lipoprotein distribution.


      We analyzed data from 5407 participants from the Multi-Ethnic Study of Atherosclerosis who had measurements of pericardial fat volume, lipoprotein distribution, carotid intima-media thickness (IMT), and coronary artery calcium (CAC). All participants were free of clinically apparent CVD at baseline. Incident CVD was defined as any adjudicated CVD event.


      After adjusting for demographic factors, traditional risk factors, and biomarkers of inflammation and hemostasis, a larger pericardial fat volume was associated with higher large VLDL particle (VLDL-P) concentration and small HDL particle (HDL-P) concentration, and smaller HDL-P size (regression coefficients = 0.585 nmol/L, 0.366 μmol/L, and −0.025 nm per SD increase in pericardial fat volume respectively, all P < 0.05). The association of pericardial fat volume with large VLDL-P concentration and HDL-P size, but not small HDL-P concentration, remained significant after further adjusting for each other as well as LDL cholesterol, HDL cholesterol, and triglycerides. The relationship of pericardial fat volume with incident CVD events, carotid IMT, and prevalence and severity of CAC did not differ by quartiles of large VLDL-P concentration, small HDL-P concentration, or HDL-P size (P for interaction>0.05).


      Pericardial fat is associated with atherogenic lipoprotein abnormalities. However, its relationship with subclinical atherosclerosis and incident CVD events does not differ according to lipoprotein distribution.


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        • Després J.P.
        • Lemieux I.
        Abdominal obesity and metabolic syndrome.
        Nature. 2006; 444: 881-887
        • Mazurek T.
        • Zhang L.
        • Zalewski A.
        • Mannion J.D.
        • Diehl J.T.
        • Arafat H.
        • et al.
        Human epicardial adipose tissue is a source of inflammatory mediators.
        Circulation. 2003; 108: 2460-2466
        • Lim S.
        • Meigs J.B.
        Ectopic fat and cardiometabolic and vascular risk.
        Int. J. Cardiol. 2013; 169: 166-176
        • Konishi M.
        • Sugiyama S.
        • Sato Y.
        • Oshima S.
        • Sugamura K.
        • Nozaki T.
        • et al.
        Pericardial fat inflammation correlates with coronary artery disease.
        Atherosclerosis. 2010; 213: 649-655
        • Ding J.
        • Hsu F.C.
        • Harris T.B.
        • Liu Y.
        • Kritchevsky S.B.
        • Szklo M.
        • et al.
        The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Am. J. Clin. Nutr. 2009; 90: 499-504
        • Cheng V.Y.
        • Dey D.
        • Tamarappoo B.
        • Nakazato R.
        • Gransar H.
        • Miranda-Peats R.
        • et al.
        Pericardial fat burden on ECG-gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events.
        JACC Cardiovasc Imaging. 2010; 3: 352-360
        • Mahabadi A.A.
        • Massaro J.M.
        • Rosito G.A.
        • Levy D.
        • Murabito J.M.
        • Wolf P.A.
        • et al.
        Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study.
        Eur. Heart J. 2009; 30: 850-856
        • Konishi M.
        • Sugiyama S.
        • Sugamura K.
        • Nozaki T.
        • Ohba K.
        • Matsubara J.
        • et al.
        Association of pericardial fat accumulation rather than abdominal obesity with coronary atherosclerotic plaque formation in patients with suspected coronary artery disease.
        Atherosclerosis. 2010; 209: 573-578
        • Yun C.H.
        • Lin T.Y.
        • Wu Y.J.
        • Liu C.C.
        • Kuo J.Y.
        • Yeh H.I.
        • et al.
        Pericardial and thoracic peri-aortic adipose tissues contribute to systemic inflammation and calcified coronary atherosclerosis independent of body fat composition, anthropometric measures and traditional cardiovascular risks.
        Eur. J. Radiol. 2012; 81: 749-756
        • Liu J.
        • Fox C.S.
        • Hickson D.
        • Sarpong D.
        • Ekunwe L.
        • May W.D.
        • et al.
        Pericardial adipose tissue, atherosclerosis, and cardiovascular disease risk factors: the Jackson heart study.
        Diabetes Care. 2010; 33: 1635-1639
        • Brinkley T.E.
        • Hsu F.C.
        • Carr J.J.
        • Hundley W.G.
        • Bluemke D.A.
        • Polak J.F.
        • et al.
        Pericardial fat is associated with carotid stiffness in the Multi-Ethnic Study of Atherosclerosis.
        Nutr. Metab. Cardiovasc Dis. 2011; 21: 332-338
        • Al Chekakie M.O.
        • Welles C.C.
        • Metoyer R.
        • Ibrahim A.
        • Shapira A.R.
        • Cytron J.
        • et al.
        Pericardial fat is independently associated with human atrial fibrillation.
        J. Am. Coll. Cardiol. 2010; 56: 784-788
        • St-Pierre A.C.
        • Cantin B.
        • Dagenais G.R.
        • Mauriège P.
        • Bernard P.M.
        • Després J.P.
        • et al.
        Low-density lipoprotein subfractions and the long-term risk of ischemic heart disease in men: 13-year follow-up data from the Québec Cardiovascular Study.
        Arterioscler. Thromb. Vasc. Biol. 2005; 25: 553-559
        • Lamarche B.
        • Tchernof A.
        • Moorjani S.
        • Cantin B.
        • Dagenais G.R.
        • Lupien P.J.
        • et al.
        Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Québec Cardiovascular Study.
        Circulation. 1997; 95: 69-75
        • Mackey R.H.
        • Greenland P.
        • Goff Jr., D.C.
        • Lloyd-Jones D.
        • Sibley C.T.
        • Mora S.
        High-density lipoprotein cholesterol and particle concentrations, carotid atherosclerosis, and coronary events: MESA (multi-ethnic study of atherosclerosis).
        J. Am. Coll. Cardiol. 2012; 60: 508-516
        • Kremen J.
        • Dolinkova M.
        • Krajickova J.
        • Blaha J.
        • Anderlova K.
        • Lacinova Z.
        • et al.
        Increased subcutaneous and epicardial adipose tissue production of proinflammatory cytokines in cardiac surgery patients: possible role in postoperative insulin resistance.
        J. Clin. Endocrinol. Metab. 2006; 91: 4620-4627
        • Garvey W.T.
        • Kwon S.
        • Zheng D.
        • Shaughnessy S.
        • Wallace P.
        • Hutto A.
        • et al.
        Effects of insulin resistance and type 2 diabetes on lipoprotein subclass particle size and concentration determined by nuclear magnetic resonance.
        Diabetes. 2003; 52: 453-462
        • Goff Jr., D.C.
        • D'Agostino Jr., R.B.
        • Haffner S.M.
        • Otvos J.D.
        Insulin resistance and adiposity influence lipoprotein size and subclass concentrations. Results from the Insulin Resistance Atherosclerosis Study.
        Metabolism. 2005; 54: 264-270
        • Bild D.E.
        • Bluemke D.A.
        • Burke G.L.
        • Detrano R.
        • Diez Roux A.V.
        • Folsom A.R.
        • et al.
        Multi-ethnic study of atherosclerosis: objectives and design.
        Am. J. Epidemiol. 2002; 156: 871-881
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin. Chem. 1972; 18: 499-502
        • Mora S.
        • Szklo M.
        • Otvos J.D.
        • Greenland P.
        • Psaty B.M.
        • Goff Jr., D.C.
        • et al.
        LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA).
        Atherosclerosis. 2007; 192: 211-217
        • de Boer I.H.
        • Astor B.C.
        • Kramer H.
        • Palmas W.
        • Rudser K.
        • Seliger S.L.
        • et al.
        Mild elevations of urine albumin excretion are associated with atherogenic lipoprotein abnormalities in the Multi-Ethnic Study of Atherosclerosis (MESA).
        Atherosclerosis. 2008; 197: 407-414
        • Carr J.J.
        • Nelson J.C.
        • Wong N.D.
        • McNitt-Gray M.
        • Arad Y.
        • Jacobs Jr., D.R.
        • et al.
        Calcified coronary artery plaque measurement with cardiac CT in population-based studies: standardized protocol of Multi-Ethnic Study of Atherosclerosis (MESA) and Coronary Artery Risk Development in Young Adults (CARDIA) study.
        Radiology. 2005; 234: 35-43
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • Zusmer N.R.
        • Viamonte Jr., M.
        • Detrano R.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J. Am. Coll. Cardiol. 1990; 15: 827-832
        • O'Leary D.H.
        • Polak J.F.
        • Kronmal R.A.
        • Manolio T.A.
        • Burke G.L.
        • Wolfson Jr., S.K.
        Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group.
        N. Engl. J. Med. 1999; 340: 14-22
        • Folsom A.R.
        • Kronmal R.A.
        • Detrano R.C.
        • O'Leary D.H.
        • Bild D.E.
        • Bluemke D.A.
        • et al.
        Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Arch. Intern Med. 2008; 168: 1333-1339
        • Soliman E.Z.
        • Ding J.
        • Hsu F.C.
        • Carr J.J.
        • Polak J.F.
        • Goff Jr., D.C.
        Association between carotid intima-media thickness and pericardial fat in the Multi-Ethnic Study of Atherosclerosis (MESA).
        J. Stroke Cerebrovasc. Dis. 2010; 19: 58-65
        • Bertoni A.G.
        • Whitt-Glover M.C.
        • Chung H.
        • Le K.Y.
        • Barr R.G.
        • Mahesh M.
        • et al.
        The association between physical activity and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis.
        Am. J. Epidemiol. 2009; 169: 444-454
        • Wallace T.M.
        • Levy J.C.
        • Matthews D.R.
        Use and abuse of HOMA modeling.
        Diabetes Care. 2004; 27: 1487-1495
        • Veeranna V.
        • Zalawadiya S.K.
        • Niraj A.
        • Kumar A.
        • Ference B.
        • Afonso L.
        Association of novel biomarkers with future cardiovascular events is influenced by ethnicity: results from a multi-ethnic cohort.
        Int. J. Cardiol. 2013; 166: 487-493
        • Ong K.L.
        • Ding J.
        • McClelland R.L.
        • Cheung B.M.
        • Criqui M.H.
        • Barter P.J.
        • et al.
        Relationship of pericardial fat with biomarkers of inflammation and hemostasis, and cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis.
        Atherosclerosis. 2015; 239: 386-392
        • Allison M.A.
        • Budoff M.J.
        • Nasir K.
        • Wong N.D.
        • Detrano R.
        • Kronmal R.
        • et al.
        Ethnic-specific risks for atherosclerotic calcification of the thoracic and abdominal aorta (from the Multi-Ethnic Study of Atherosclerosis).
        Am. J. Cardiol. 2009; 104: 812-817
        • Freedman D.S.
        • Otvos J.D.
        • Jeyarajah E.J.
        • Barboriak J.J.
        • Anderson A.J.
        • Walker J.A.
        Relation of lipoprotein subclasses as measured by proton nuclear magnetic resonance spectroscopy to coronary artery disease.
        Arterioscler. Thromb. Vasc. Biol. 1998; 18: 1046-1053
        • Mora S.
        • Otvos J.D.
        • Rifai N.
        • Rosenson R.S.
        • Buring J.E.
        • Ridker P.M.
        Lipoprotein particle profiles by nuclear magnetic resonance compared with standard lipids and apolipoproteins in predicting incident cardiovascular disease in women.
        Circulation. 2009; 119: 931-939
        • Paynter N.P.
        • Sesso H.D.
        • Conen D.
        • Otvos J.D.
        • Mora S.
        Lipoprotein subclass abnormalities and incident hypertension in initially healthy women.
        Clin. Chem. 2011; 57: 1178-1187
        • Fitzgibbons T.P.
        • Czech M.P.
        Epicardial and perivascular adipose tissues and their influence on cardiovascular disease: basic mechanisms and clinical associations.
        J. Am. Heart Assoc. 2014; 3: e000582
        • Tadros T.M.
        • Massaro J.M.
        • Rosito G.A.
        • Hoffmann U.
        • Vasan R.S.
        • Larson M.G.
        • et al.
        Pericardial fat volume correlates with inflammatory markers: the Framingham Heart Study.
        Obes. (Silver Spring). 2010; 18: 1039-1045