Postmenopausal women with greater paracardial fat have more coronary artery calcification than premenopausal women

The Study of Women's Health Across the Nation (SWAN) cardiovascular fat ancillary study

Samar R. El Khoudary, Kelly J. Shields, Imke Janssen, Matthew J. Budoff, Susan A. Everson-Rose, Lynda H. Powell, Karen A. Matthews

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background-Volumes of paracardial adipose tissue (PAT) and epicardial adipose tissue (EAT) are greater after menopause. Interestingly, PAT but not EAT is associated with estradiol decline, suggesting a potential role of menopause in PAT accumulation. We assessed whether volumes of heart fat depot (EAT and PAT) were associated with coronary artery calcification (CAC) in women at midlife and whether these associations were modified by menopausal status and estradiol levels. Methods and Results-EAT and PAT volumes and CAC were measured using electron beam computed tomography scans. CAC was evaluated as (1) the presence of CAC (CAC Agatston score ≥10) and (2) the extent of any CAC (log CAC Agatston score > 0). The study included 478 women aged 50.9 years (58% pre- or early perimenopausal, 10% late perimenopausal, and 32% postmenopausal). EAT was significantly associated with CAC measures, and these associations were not modified by menopausal status or estradiol. In contrast, associations between PAT and CAC measures were modified by menopausal status (interaction-P≤0.01). Independent of study covariates including other adiposity measures, each 1-SD unit increase in log PAT was associated with 102% higher risk of CAC presence (P=0.04) and an 80% increase in CAC extent (P=0.008) in postmenopausal women compared with pre- or early perimenopausal women. Additional adjustment for estradiol and hormone therapy attenuated these differences. Moreover, the association between PAT and CAC extent was stronger in women with lower estradiol levels (interaction P=0.004). Conclusions-The findings suggest that PAT is a potential menopause-specific coronary artery disease risk marker, supporting the need to monitor and target this fat depot for intervention in women at midlife.

Original languageEnglish (US)
Article numbere004545
JournalJournal of the American Heart Association
Volume6
Issue number2
DOIs
StatePublished - Jan 1 2017

Fingerprint

Women's Health
Adipose Tissue
Coronary Vessels
Fats
Estradiol
Menopause
Cardiac Volume
X Ray Computed Tomography
Adiposity
Coronary Artery Disease

Keywords

  • Calcification
  • Epicardial fat
  • Menopause
  • Paracardial fat

Cite this

Postmenopausal women with greater paracardial fat have more coronary artery calcification than premenopausal women : The Study of Women's Health Across the Nation (SWAN) cardiovascular fat ancillary study. / El Khoudary, Samar R.; Shields, Kelly J.; Janssen, Imke; Budoff, Matthew J.; Everson-Rose, Susan A.; Powell, Lynda H.; Matthews, Karen A.

In: Journal of the American Heart Association, Vol. 6, No. 2, e004545, 01.01.2017.

Research output: Contribution to journalArticle

@article{66ebcaccee114e4bad5c4820900ebe0f,
title = "Postmenopausal women with greater paracardial fat have more coronary artery calcification than premenopausal women: The Study of Women's Health Across the Nation (SWAN) cardiovascular fat ancillary study",
abstract = "Background-Volumes of paracardial adipose tissue (PAT) and epicardial adipose tissue (EAT) are greater after menopause. Interestingly, PAT but not EAT is associated with estradiol decline, suggesting a potential role of menopause in PAT accumulation. We assessed whether volumes of heart fat depot (EAT and PAT) were associated with coronary artery calcification (CAC) in women at midlife and whether these associations were modified by menopausal status and estradiol levels. Methods and Results-EAT and PAT volumes and CAC were measured using electron beam computed tomography scans. CAC was evaluated as (1) the presence of CAC (CAC Agatston score ≥10) and (2) the extent of any CAC (log CAC Agatston score > 0). The study included 478 women aged 50.9 years (58{\%} pre- or early perimenopausal, 10{\%} late perimenopausal, and 32{\%} postmenopausal). EAT was significantly associated with CAC measures, and these associations were not modified by menopausal status or estradiol. In contrast, associations between PAT and CAC measures were modified by menopausal status (interaction-P≤0.01). Independent of study covariates including other adiposity measures, each 1-SD unit increase in log PAT was associated with 102{\%} higher risk of CAC presence (P=0.04) and an 80{\%} increase in CAC extent (P=0.008) in postmenopausal women compared with pre- or early perimenopausal women. Additional adjustment for estradiol and hormone therapy attenuated these differences. Moreover, the association between PAT and CAC extent was stronger in women with lower estradiol levels (interaction P=0.004). Conclusions-The findings suggest that PAT is a potential menopause-specific coronary artery disease risk marker, supporting the need to monitor and target this fat depot for intervention in women at midlife.",
keywords = "Calcification, Epicardial fat, Menopause, Paracardial fat",
author = "{El Khoudary}, {Samar R.} and Shields, {Kelly J.} and Imke Janssen and Budoff, {Matthew J.} and Everson-Rose, {Susan A.} and Powell, {Lynda H.} and Matthews, {Karen A.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1161/JAHA.116.004545",
language = "English (US)",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Postmenopausal women with greater paracardial fat have more coronary artery calcification than premenopausal women

T2 - The Study of Women's Health Across the Nation (SWAN) cardiovascular fat ancillary study

AU - El Khoudary, Samar R.

AU - Shields, Kelly J.

AU - Janssen, Imke

AU - Budoff, Matthew J.

AU - Everson-Rose, Susan A.

AU - Powell, Lynda H.

AU - Matthews, Karen A.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background-Volumes of paracardial adipose tissue (PAT) and epicardial adipose tissue (EAT) are greater after menopause. Interestingly, PAT but not EAT is associated with estradiol decline, suggesting a potential role of menopause in PAT accumulation. We assessed whether volumes of heart fat depot (EAT and PAT) were associated with coronary artery calcification (CAC) in women at midlife and whether these associations were modified by menopausal status and estradiol levels. Methods and Results-EAT and PAT volumes and CAC were measured using electron beam computed tomography scans. CAC was evaluated as (1) the presence of CAC (CAC Agatston score ≥10) and (2) the extent of any CAC (log CAC Agatston score > 0). The study included 478 women aged 50.9 years (58% pre- or early perimenopausal, 10% late perimenopausal, and 32% postmenopausal). EAT was significantly associated with CAC measures, and these associations were not modified by menopausal status or estradiol. In contrast, associations between PAT and CAC measures were modified by menopausal status (interaction-P≤0.01). Independent of study covariates including other adiposity measures, each 1-SD unit increase in log PAT was associated with 102% higher risk of CAC presence (P=0.04) and an 80% increase in CAC extent (P=0.008) in postmenopausal women compared with pre- or early perimenopausal women. Additional adjustment for estradiol and hormone therapy attenuated these differences. Moreover, the association between PAT and CAC extent was stronger in women with lower estradiol levels (interaction P=0.004). Conclusions-The findings suggest that PAT is a potential menopause-specific coronary artery disease risk marker, supporting the need to monitor and target this fat depot for intervention in women at midlife.

AB - Background-Volumes of paracardial adipose tissue (PAT) and epicardial adipose tissue (EAT) are greater after menopause. Interestingly, PAT but not EAT is associated with estradiol decline, suggesting a potential role of menopause in PAT accumulation. We assessed whether volumes of heart fat depot (EAT and PAT) were associated with coronary artery calcification (CAC) in women at midlife and whether these associations were modified by menopausal status and estradiol levels. Methods and Results-EAT and PAT volumes and CAC were measured using electron beam computed tomography scans. CAC was evaluated as (1) the presence of CAC (CAC Agatston score ≥10) and (2) the extent of any CAC (log CAC Agatston score > 0). The study included 478 women aged 50.9 years (58% pre- or early perimenopausal, 10% late perimenopausal, and 32% postmenopausal). EAT was significantly associated with CAC measures, and these associations were not modified by menopausal status or estradiol. In contrast, associations between PAT and CAC measures were modified by menopausal status (interaction-P≤0.01). Independent of study covariates including other adiposity measures, each 1-SD unit increase in log PAT was associated with 102% higher risk of CAC presence (P=0.04) and an 80% increase in CAC extent (P=0.008) in postmenopausal women compared with pre- or early perimenopausal women. Additional adjustment for estradiol and hormone therapy attenuated these differences. Moreover, the association between PAT and CAC extent was stronger in women with lower estradiol levels (interaction P=0.004). Conclusions-The findings suggest that PAT is a potential menopause-specific coronary artery disease risk marker, supporting the need to monitor and target this fat depot for intervention in women at midlife.

KW - Calcification

KW - Epicardial fat

KW - Menopause

KW - Paracardial fat

UR - http://www.scopus.com/inward/record.url?scp=85016076386&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85016076386&partnerID=8YFLogxK

U2 - 10.1161/JAHA.116.004545

DO - 10.1161/JAHA.116.004545

M3 - Article

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 2

M1 - e004545

ER -