Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery

Background Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Methods Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery (non-CABG). Results In men, EATV, EATV index (EATV/body surface area) and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP) and type 2 diabetes mellitus (Corrected R2 = 0.262, p < 0.0001), while in women, type 2 diabetes mellitus is a single strong predictor for CABG, excluding EATV Index (Corrected R2 = 0.266, p = 0.005). Conclusions Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.

[1]  H. Sakaue,et al.  Depot- and gender-specific expression of NLRP3 inflammasome and toll-like receptors in adipose tissue of cancer patients. , 2016, BioFactors.

[2]  Buring,et al.  Cardiovascular Disease in Women: Clinical Perspectives. , 2016, Circulation research.

[3]  Gianluca Iacobellis,et al.  Local and systemic effects of the multifaceted epicardial adipose tissue depot , 2015, Nature Reviews Endocrinology.

[4]  L. Smeeth,et al.  How Does Cardiovascular Disease First Present in Women and Men , 2015 .

[5]  Zhenjie Wu,et al.  Adiponectin is associated with increased mortality in patients with already established cardiovascular disease: a systematic review and meta-analysis. , 2014, Metabolism: clinical and experimental.

[6]  M. Czech,et al.  Epicardial and Perivascular Adipose Tissues and Their Influence on Cardiovascular Disease: Basic Mechanisms and Clinical Associations , 2014, Journal of the American Heart Association.

[7]  Á. Fernández-Trasancos,et al.  Adiponectin and p53 mRNA in epicardial and subcutaneous fat from heart failure patients , 2014, European journal of clinical investigation.

[8]  Zhenjie Wu,et al.  Association between Adiponectin Concentrations and Cardiovascular Disease in Diabetic Patients: A Systematic Review and Meta-Analysis , 2013, PloS one.

[9]  J. Després,et al.  Perivascular adipose tissue in the pathogenesis of cardiovascular disease. , 2013, Atherosclerosis.

[10]  Udo Hoffmann,et al.  Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. , 2013, Journal of the American College of Cardiology.

[11]  Michael J Blaha,et al.  High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link? , 2013, Journal of the American College of Cardiology.

[12]  MichioShimabukuro,et al.  Epicardial Adipose Tissue Volume and Adipocytokine Imbalance Are Strongly Linked to Human Coronary Atherosclerosis , 2013 .

[13]  T. Wakatsuki,et al.  Gender disparities in the association between epicardial adipose tissue volume and coronary atherosclerosis: A 3-dimensional cardiac computed tomography imaging study in Japanese subjects , 2012, Cardiovascular Diabetology.

[14]  M. Tolan,et al.  Gender influence in isolated coronary artery bypass graft surgery: a propensity match score analysis of early outcomes , 2012, General Thoracic and Cardiovascular Surgery.

[15]  C. Reid,et al.  Sex differences in outcomes following isolated coronary artery bypass graft surgery in Australian patients: analysis of the Australasian Society of Cardiac and Thoracic Surgeons cardiac surgery database. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[16]  Samer A M Nashef,et al.  EuroSCORE II. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[17]  Damini Dey,et al.  Threshold for the upper normal limit of indexed epicardial fat volume: derivation in a healthy population and validation in an outcome-based study. , 2011, The American journal of cardiology.

[18]  Kohjiro Ueki,et al.  Report of the Committee on the Classification and Diagnostic Criteria of Diabetes Mellitus , 2010, Journal of diabetes investigation.

[19]  D. Clegg,et al.  A microarray analysis of sexual dimorphism of adipose tissues in high-fat-diet-induced obese mice , 2010, International Journal of Obesity.

[20]  Damini Dey,et al.  Pericardial fat burden on ECG-gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events. , 2010, JACC. Cardiovascular imaging.

[21]  Sean M. O'Brien,et al.  The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery. , 2009, The Annals of thoracic surgery.

[22]  A. Heagerty,et al.  Local Inflammation and Hypoxia Abolish the Protective Anticontractile Properties of Perivascular Fat in Obese Patients , 2009, Circulation.

[23]  M. Shimabukuro.  Cardiac adiposity and global cardiometabolic risk: new concept and clinical implication. , 2009, Circulation journal : official journal of the Japanese Circulation Society.

[24]  L. Shaw,et al.  Impact of Ethnicity and Gender Differences on Angiographic Coronary Artery Disease Prevalence and In-Hospital Mortality in the American College of Cardiology–National Cardiovascular Data Registry , 2008, Circulation.

[25]  T. Funahashi,et al.  Future adverse cardiac events can be predicted by persistently low plasma adiponectin concentrations in men and marked reductions of adiponectin in women after acute myocardial infarction. , 2007, Atherosclerosis.

[26]  M. Trevisan,et al.  Sex Differences in Endothelial Function Markers Before Conversion to Pre-Diabetes: Does the Clock Start Ticking Earlier Among Women? , 2007, Diabetes Care.

[27]  T. Funahashi,et al.  Systemic oxidative stress is associated with visceral fat accumulation and the metabolic syndrome. , 2006, Circulation journal : official journal of the Japanese Circulation Society.

[28]  Carl J Pepine,et al.  Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. , 2006, Journal of the American College of Cardiology.

[29]  S. Reis,et al.  Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. , 2006, Journal of the American College of Cardiology.

[30]  Po Box,et al.  Excess risk of fatal coronary heart disease associated with diabetes in men and women:meta-analysis of 37 prospective cohort studies , 2006 .

[31]  Seppo Lehto,et al.  Gender difference in the impact of type 2 diabetes on coronary heart disease risk. , 2004, Diabetes care.

[32]  K. Smith,et al.  Abnormal Coronary Vasomotion as a Prognostic Indicator of Cardiovascular Events in Women: Results From the National Heart, Lung, and Blood Institute–Sponsored Women’s Ischemia Syndrome Evaluation (WISE) , 2004, Circulation.

[33]  J. Keijer,et al.  Gene expression profiling of adipose tissue: individual, depot-dependent, and sex-dependent variabilities. , 2004, Nutrition.

[34]  T. Funahashi,et al.  Hypoadiponectinemia is closely linked to endothelial dysfunction in man. , 2003, The Journal of clinical endocrinology and metabolism.

[35]  J. Smith,et al.  The influence of gender in patients undergoing coronary artery bypass graft surgery: an eight-year prospective hospitalized cohort study. , 2003, Journal of the American College of Surgeons.

[36]  R. Klein,et al.  Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study. , 2002, JAMA.

[37]  Ose,et al.  Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events* , 2002 .

[38]  M. Carr.  Diabetes mellitus: a hypercoagulable state. , 2001, Journal of diabetes and its complications.

[39]  A. Baron,et al.  Type II diabetes abrogates sex differences in endothelial function in premenopausal women. , 2000, Circulation.

[40]  T Nakamura,et al.  Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. , 1999, Biochemical and biophysical research communications.

[41]  S. Haffner,et al.  Relatively more atherogenic coronary heart disease risk factors in prediabetic women than in prediabetic men , 1997, Diabetologia.

[42]  Y. Matsuzawa,et al.  Pathophysiology and pathogenesis of visceral fat obesity. , 1995, Annals of the New York Academy of Sciences.

[43]  E. Barrett-Connor,et al.  Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study. , 1991, JAMA.

[44]  G. Gensini,et al.  A more meaningful scoring system for determining the severity of coronary heart disease. , 1983, The American journal of cardiology.