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 journalArticlepeer-review

29 Scopus citations


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
Issue number2
StatePublished - 2017

Bibliographical note

Funding Information:
Clinical Centers: University of Michigan, Ann Arbor-Siobán Harlow, PI 2011-present, MaryFran Sowers, PI 1994-2011; Massachusetts General Hospital, Boston, MA-Joel Finkelstein, PI 1999-present; Robert Neer, PI 1994-1999; Rush University, Rush University Medical Center, Chicago, IL-Howard Kravitz, PI 2009-present; Lynda H. Powell, PI 1994-2009; University of California, Davis/Kaiser-Ellen Gold, PI; University of California, Los Angeles-Gail Greendale, PI; Albert Einstein College of Medicine, Bronx, NY-Carol Derby, PI 2011-present, Rachel Wildman, PI 2010-2011; Nanette Santoro, PI 2004-2010; University of Medicine and Dentistry-New Jersey Medical School, Newark-Gerson Weiss, PI 1994-2004; and the University of Pittsburgh, Pittsburgh, PA-Karen Matthews, PI. NIH Program Office: National Institute on Aging, Bethesda, MD-Chhanda Dutta 2016-present; Winifred Rossi 2012-2016; Sherry Sherman 1994-2012; Marcia Ory 1994-2001; National Institute of Nursing Research, Bethesda, MD-Program Officers. Central Laboratory: University of Michigan, Ann Arbor-Daniel McConnell (Central Ligand Assay Satellite Services). Coordinating Center: University of Pittsburgh, Pittsburgh, PA-Maria Mori Brooks, PI 2012-present; Kim Sutton-Tyrrell, PI 2001-2012; New England Research Institutes, Watertown, MA-Sonja McKinlay, PI 1995-2001. Steering Committee: Susan Johnson, Current Chair. Chris Gallagher, Former Chair. We thank the study staffat each site and all the women who participated in SWAN. The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), Department of Health and Human Services, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women's Health (ORWH) (Grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG 012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). SWAN Heart was supported by the National Heart, Lung, and Blood Institute (Grants HL065581, HL065591). The SWAN Cardiovascular Fat Ancillary Study was supported by an award from the American Heart Association Great River Affiliation Clinical Research Program: 12CRP11900031. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH.

Publisher Copyright:
© 2017 The Authors.


  • Calcification
  • Epicardial fat
  • Menopause
  • Paracardial fat


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