Mangili Leonardo C, Mangili Otavio C, Bittencourt Márcio S, Miname Márcio H, Harada Paulo H, Lima Leonardo M, Rochitte Carlos E, Santos Raul D
Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil.
Center for Clinical and Epidemiological Research and Division of Internal Medicine, University Hospital, University of Sao Paulo, Sao Paulo, SP, Brazil.
Atherosclerosis. 2016 Nov;254:73-77. doi: 10.1016/j.atherosclerosis.2016.09.010. Epub 2016 Sep 9.
Familial hypercholesterolemia (FH) is a common genetic disorder characterized by elevated blood cholesterol, increased prevalence of subclinical atherosclerosis and high risk of premature coronary heart disease. However, this risk is not explained solely by elevated LDL-cholesterol concentrations, and other factors may influence atherosclerosis development. There is evidence that increased adiposity may predispose to atherosclerosis in FH. Epicardial fat has been associated with subclinical coronary atherosclerosis in the general population. This study evaluated the association of epicardial fat (EFV) volume with the presence and extent of subclinical coronary atherosclerosis detected by computed tomography angiography in FH patients.
Ninety-seven FH subjects (35% male, mean age 45 ± 13 years, LDL-C 281 ± 56 mg/dL, 67% with proven molecular defects) underwent computed tomography angiography and coronary artery calcium (CAC) scoring. EFV was measured in non-contrast images using a semi-automated method. Segment-stenosis score (SSS) and segment-involvement score (SIS) were calculated. Multivariate Poisson regression was utilized to assess an independent association of EFV with coronary atherosclerotic burden.
EFV was positively associated with age, body mass index, waist circumference, blood glucose, the presence of the metabolic syndrome components, but not with LDL-C. After adjusting for confounders and abdominal circumference, an independent association (shown as β coefficients and 95% confidence intervals) of EVF with CAC scores [β = 0.263 (0.234; 0.292), p=0.000], SIS [β = 0.304 (0.141; 0.465) p=0.000] and SSS [β = 0.296 (0.121; 0.471), p=0.001] was found.
In FH, EFV was independently associated with coronary atherosclerotic presence and severity.
家族性高胆固醇血症（FH）是一种常见的遗传性疾病，其特征为血液胆固醇升高、亚临床动脉粥样硬化患病率增加以及早发冠心病风险高。然而，这种风险并不能仅由低密度脂蛋白胆固醇浓度升高来解释，其他因素可能会影响动脉粥样硬化的发展。有证据表明，肥胖增加可能使FH患者易患动脉粥样硬化。在一般人群中，心外膜脂肪已与亚临床冠状动脉粥样硬化相关。本研究评估了FH患者的心外膜脂肪体积（EFV）与计算机断层扫描血管造影检测到的亚临床冠状动脉粥样硬化的存在及程度之间的关联。
97名FH受试者（35%为男性，平均年龄45±13岁，低密度脂蛋白胆固醇281±56mg/dL，67%有经证实的分子缺陷）接受了计算机断层扫描血管造影和冠状动脉钙化（CAC）评分。使用半自动方法在非增强图像中测量EFV。计算节段狭窄评分（SSS）和节段累及评分（SIS）。采用多变量泊松回归评估EFV与冠状动脉粥样硬化负担的独立关联。
EFV与年龄、体重指数、腰围、血糖、代谢综合征组分的存在呈正相关，但与低密度脂蛋白胆固醇无关。在调整混杂因素和腹围后，发现EVF与CAC评分[β=0.263（0.234；0.292），p=0.000]、SIS[β=0.304（0.141；0.465），p=0.000]和SSS[β=0.296（0.121；0.471），p=0.001]存在独立关联。
在FH中，EFV与冠状动脉粥样硬化的存在及严重程度独立相关。
