Sex-specific association of epicardial adipose tissue thickness and left ventricular hypertrophy in the older adults—cross-sectional results from the population-based AugUR study

Aim Our study aimed to evaluate epicardial adipose tissue (EAT) thickness in old adults, identify potential factors influencing it, and explore the association between EAT and left ventricular hypertrophy (LVH) in the older adult population. Methods We analyzed cross-sectional data from the population-based AugUR study, including subjects aged ≥70 years. Cardiac geometry and EAT thickness were measured by echocardiography. Results Among 988 participants aged 70–95 years (55.8% men), LVH was present in 368 individuals (37.2%). EAT thickness was similar between women and men (mean ± standard deviation: 4.1 ± 2.0 mm vs. 4.2 ± 1.9 mm, p = 0.29) but increased with age group (70–79 years: 4.0 ± 1.8 mm, >79 years 4.5 ± 2.0 mm, p < 0.001). Linear regression models of potential risk factors influencing EAT thickness showed associations with age [ β = 0.038 mm per year; 95% confidence interval (CI) = 0.014–0.063, p < 0.05], body mass index (BMI) ( β = 0.097 mm per kg/m 2 , 95% CI = 0.070–0.124, p < 0.05), and low-density lipoprotein-cholesterol (LDL, β = 0.008 mm per mg/dL, 95% CI = 0.004–0.012, p < 0.05). Given the reported causal relationship between EAT and LVH in experimental studies, multivariable regression models were performed to evaluate the association between EAT thickness and left ventricular mass index (LVMi). EAT thickness was associated with LVMi independent of sex, age, BMI, LDL, smoking, hypertension, diabetes, and chronic kidney disease (LVMi ß = 2.43 g/m 2 /mm, 95% CI 1.26–3.59, p = <0.001; LVH OR = 1.36/mm, 95% CI 1.01–1.84, p < 0.05). This association was strong in men but not in women. Conclusion EAT thickness continues to increase with age beyond 69 years. Age, BMI, and LDL-cholesterol are associated with increasing EAT thickness. Our study strengthens the experimental hypothesis of a link between EAT and LVH by translational, population-based data. However, this association is more pronounced in men than in women.