Pericardial fat confers increased risk for HF, particularly HFpEF
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Excess pericardial fat volume was associated with higher risk for HF, especially HF with preserved ejection fraction, researchers reported.
“For nearly 2 decades we have known that obesity, based on simple measurement of height and weight, can double one’s risk of heart failure, but now, we have gone a step further by using imaging technology to show that excess pericardial fat, perhaps due to its location close to the heart muscle, further augments the risk of this potentially fatal condition — heart failure,” Satish Kenchaiah, MD, associate professor of medicine (cardiology) at the Icahn School of Medicine at Mount Sinai, said in a press release.
The researchers determined pericardial fat volume (PFV) using CTA in 6,785 participants who did not have preexisting CVD from the Multi-Ethnic Study of Atherosclerosis.
According to the researchers, in 90,686 person-years of follow-up (median age, 16 years; interquartile range [IQR], 11.7-16.5), 5.7% of participants were newly diagnosed with HF.
In a multivariable analysis, every 1 standard deviation (42 cm³) rise in PFV was associated with greater risk for HF, and the effect was more pronounced in women (HR in women = 1.44; 95% CI, 1.21-1.71; P < .001; HR in men = 1.13; 95% CI, 1.01-1.27; P = .03, P for interaction = .01).
High PFV ( 70 cm3 in women; 120 cm3 in men) conferred a twofold greater risk for HF in women (HR = 2.06; 95% CI: 1.48-2.87; P < .001) and a 53% higher risk in men (HR = 1.53; 95% CI, 1.13-2.07; P = .006) compared with lower levels, according to the researchers.
The effect of PFV impacted risk for HFpEF but not HF with reduced ejection fraction. For every 1 standard deviation increase in PFV, risk for HFpEF increased by 42% (HR = 1.42; 95% CI, 1.25-1.62; P < .001), but the risk for HFrEF did not increase (HR = 1.04; 95% CI, 0.89-1.21; P = .65), whereas compared with normal PFV, elevated PFV was associated with greater risk for HFpEF (HR = 2.32; 95% CI, 1.66-3.23; P < .001) but not HFrEF (HR = 1.2; 95% CI, 0.84-1.73; P = .31), the researchers wrote.
“This work provides us with an important tool to stratify patients into higher and lower risk of heart failure, which can possibly lead to early intervention and heart failure prevention to ultimately save people’s lives,” Kenchaiah said in the release.
“This is the first cohort study demonstrating an epidemiological link between pericardial fat and incident HF. ... Further studies on whether agents with favorable metabolic profile and weight-loss interventions modify risk for HFpEF through effects on PFV, powered for sex-specific effects, are warranted,” Andreas P. Kalogeropoulos, MD, MPH, PhD, a clinical and outcomes researcher with Stony Brook University Medical Center, and Michael E. Hall, MD, MS, a cardiologist with the University of Mississippi Medical Center, wrote in a related editorial.
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