Key result
High pericardial fat volume is linked to ~106% higher incident HF risk in women.
Why the study?
Obesity is a well-established risk factor for heart failure, but the implications of pericardial fat on incident heart failure are unclear.
Does higher pericardial fat volume increase the risk of newly diagnosed heart failure in individuals without pre-existing cardiovascular disease?
Cohort (n=6,785)
Yes
Does higher pericardial fat volume increase the risk of newly diagnosed heart failure in individuals without pre-existing cardiovascular disease?
Hazard Ratio: 2.06 (95% CI 1.48–2.87)
p-value: p=<0.001
Higher pericardial fat volume is independently associated with an increased risk of incident heart failure, particularly HFpEF, in both women and men.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“People will ask why should they measure fat around the heart. Why can't they just take the waist circumference or body mass index as a measure for increased risk? Yet, when we adjusted for waist circumference, hip circumference, waist to hip ratio, and other known variables, pericardial fat was still associated with an increased risk of heart failure. This tells me that it is not just overall fat in the body but something about its location around the heart that is playing a role.”
“The most surprising part of this study was that the risk for heart failure with increased pericardial fat does not seem to be explained by obesity and systemic inflammation alone. If pericardial fat was merely a proxy for increased visceral fat, one would expect the association of pericardial fat with heart failure risk to go away after factoring in abdominal CT findings, which was not the case here. Also, accounting for inflammatory markers did not change things dramatically.”
“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.”
Pericardial fat may enhance sex-specific HF risk prediction beyond BMI; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND Obesity is a well-established risk factor for heart failure (HF). However, implications of pericardial fat on incident HF is unclear. OBJECTIVES This study sought to examine the association between pericardial fat volume (PFV) and newly diagnosed HF. METHODS This study ascertained PFV using cardiac computed tomography in 6,785 participants (3,584 women and 3,201 men) without pre-existing cardiovascular disease from the MESA (Multi-Ethnic Study of Atherosclerosis). Cox proportional hazards regression was used to evaluate PFV as continuous and dichotomous variable, maximizing the J-statistic: (Sensitivity + Specificity − 1). RESULTS In 90,686 person-years (median: 15.7 years; interquartile range: 11.7 to 16.5 years), 385 participants (5.7%; 164 women and 221 men) developed newly diagnosed HF. PFV was lower in women than in men (69 ± 33 cm3 vs. 92 ± 47 cm3; p < 0.001). In multivariable analyses, every 1-SD (42 cm3) increase in PFV was associated with a higher risk of HF in women (hazard ratio [HR]: 1.44; 95% confidence interval [CI]: 1.21 to 1.71; p < 0.001) than in men (HR: 1.13; 95% CI: 1.01 to 1.27; p = 0.03) (interaction p = 0.01). High PFV (≥70 cm3 in women; ≥120 cm3 in men) conferred a 2-fold greater risk of HF in women (HR: 2.06; 95% CI: 1.48 to 2.87; p < 0.001) and a 53% higher risk in men (HR: 1.53; 95% CI: 1.13 to 2.07; p = 0.006). In sex-stratified analyses, greater risk of HF remained robust with additional adjustment for anthropometric indicators of obesity (p ≤0.008), abdominal subcutaneous or visceral fat (p ≤ 0.03) or biomarkers of inflammation and hemodynamic stress (p < 0.001) and was similar among Whites, Blacks, Hispanics, and Chinese (interaction p = 0.24). Elevated PFV predominantly augmented the risk of HF with preserved ejection fraction (p < 0.001) rather than reduced ejection fraction (p = 0.31). CONCLUSIONS In this large, community-based, ethnically diverse, prospective cohort study, pericardial fat was associated with an increased risk of HF, particularly HF with preserved ejection fraction, in women and men.
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Kenchaiah et al. (2021) conducted a cohort in Heart failure (n=6,785). High pericardial fat volume vs. Lower pericardial fat volume was evaluated on Newly diagnosed HF (HR 2.06, 95% CI 1.48-2.87, p=<0.001). High pericardial fat volume conferred a 2-fold greater risk of incident heart failure in women (HR 2.06; 95% CI 1.48-2.87) and a 53% higher risk in men (HR 1.53; 95% CI 1.13-2.07).
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