Pericardial Fat Volume Helps Predict Incident Heart Failure, Even After Adjustment for Obesity

Satish Kenchaiah, MD, MPH

An analysis of data within the Multi-Ethnic Study of Atherosclerosis (MESA) study suggests using computed tomography to measure pericardial fat volume could help predict risk of incident heart failure, particularly among women.

The study, which was funded in part by the National Heart, Lung, and Blood Institute and the National Center for Advancing Translational Sciences, concluded elevated pericardial fat volume was associated with a 2-fold increase in risk among women and 53% greater risk in men while also providing insight into the impact of incremental increases in pericardial fat volume on incident heart failure.

"For nearly two 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" explains lead researcher Satish Kenchaiah, MD, MPH, Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai, in a statement. "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."

With an apparent knowledge gap existing related to the association of pericardial fat and incident heart failure, Kenchaiah and a team of colleagues sought to fill this gap by performing an analysis of a large, community-based, ethnically diverse, prospective cohort. Using the MESA study, investigators identified a cohort of 6785 patients, including 3584 women and 3201 men, without cardiovascular and with information related to pericardial fat volume ascertained through cardiac CT and complete follow-up data.

From this cohort, investigators obtained 90,686 person-years of follow-up data. During this time period, 385 (164 women, 221 men) participants developed incident heart failure. Overall, pericardial fat volume was lower among women included in the study than men (69±33cm³ vs 92±47 cm³; P <.001).

For the purpose of analysis, investigators planned to use Cox proportional hazards regression to evaluate pericardial fat volume as a continuous and dichotomous variable. Information related to demographic variables, medical history, medication use, and other factors were used as covariates in adjusted analyses.

In adjusted analyses, each 1-SD (42 cm³) increase in pericardial fat volume was associated with a 44% increase in risk of incident heart failure among women (HR, 1.44; 95% CI, 1.21-1.71; P <.001) and a 13% increase in risk among men (HR, 1.13; 955 CI, 1.01-1.27; P=.03). When comparing those with elevated pericardial fat volume, which was defined as greater than 70 cm³ in women and greater than 120 cm³ in men, elevated pericardial fat volume was associated with more than double the risk of heart failure among women (HR, 2.06; 95% CI, 1.48-2.87; P <.001) and a 53% increase in risk among men (HR, 1.53; 95% CI, 1.13-2.07; P=.006).

The increased risk of heart failure remained robust in sex-stratified analyses, even after adjustment for indicators of obesity (P ≤.008), abdominal subcutaneous or visceral fat (P ≤0.03), or biomarkers of inflammation and hemodynamic stress (P <.001). Investigators also pointed out this trend was similar across multiple racial/ethnic subgroups.

Investigators pointed out the effect of pericardial fat volume was more significant among patients with preserved ejection fraction (P <.001) than those with reduced ejection fraction (P=.31).

"Our research provides strong evidence that excess pericardial fat substantially raises the risk of heart failure,” added Kenchaiah. "Additional studies are needed to confirm our findings. Future research in this field should also focus on ways and means, such as eating a heart-healthy diet and staying physically active, to achieve and maintain optimal body weight and reduce and avoid fat deposition around the heart."

This study, “Pericardial Fat and the Risk of Heart Failure,” was published in the Journal of the American College of Cardiology.