Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2017 Jan 29;6(2):e004545.
doi: 10.1161/JAHA.116.004545.

Postmenopausal Women With Greater Paracardial Fat Have More Coronary Artery Calcification Than Premenopausal Women: The Study of Women's Health Across the Nation (SWAN) Cardiovascular Fat Ancillary Study

Samar R El Khoudary  1 , Kelly J Shields  2 , Imke Janssen  3 , Matthew J Budoff  4 , Susan A Everson-Rose  5 , Lynda H Powell  3 , Karen A Matthews  6   7
Affiliations
Multicenter Study

Postmenopausal Women With Greater Paracardial Fat Have More Coronary Artery Calcification Than Premenopausal Women: The Study of Women's Health Across the Nation (SWAN) Cardiovascular Fat Ancillary Study

Samar R El Khoudary et al. J Am Heart Assoc. .

Abstract

Background: Volumes of paracardial adipose tissue (PAT) and epicardial adipose tissue (EAT) are greater after menopause. Interestingly, PAT but not EAT is associated with estradiol decline, suggesting a potential role of menopause in PAT accumulation. We assessed whether volumes of heart fat depot (EAT and PAT) were associated with coronary artery calcification (CAC) in women at midlife and whether these associations were modified by menopausal status and estradiol levels.

Methods and results: EAT and PAT volumes and CAC were measured using electron beam computed tomography scans. CAC was evaluated as (1) the presence of CAC (CAC Agatston score ≥10) and (2) the extent of any CAC (log CAC Agatston score >0). The study included 478 women aged 50.9 years (58% pre- or early perimenopausal, 10% late perimenopausal, and 32% postmenopausal). EAT was significantly associated with CAC measures, and these associations were not modified by menopausal status or estradiol. In contrast, associations between PAT and CAC measures were modified by menopausal status (interaction-P≤0.01). Independent of study covariates including other adiposity measures, each 1-SD unit increase in log PAT was associated with 102% higher risk of CAC presence (P=0.04) and an 80% increase in CAC extent (P=0.008) in postmenopausal women compared with pre- or early perimenopausal women. Additional adjustment for estradiol and hormone therapy attenuated these differences. Moreover, the association between PAT and CAC extent was stronger in women with lower estradiol levels (interaction P=0.004).

Conclusions: The findings suggest that PAT is a potential menopause-specific coronary artery disease risk marker, supporting the need to monitor and target this fat depot for intervention in women at midlife.

Keywords: calcification; epicardial fat; menopause; paracardial fat.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Predicted geometric means of CAC extent by tertiles of PAT and E2. *Adjusted for study site, race/ethnicity, age, menopausal status, obesity, systolic blood pressure, smoking, log triglycerides, medication use, hormone therapy use, cycle day of the blood draw. P=0.04 for interaction between PAT tertiles and E2 tertiles. P=0.004 for interaction between PAT and E2 as continuous measures. E2 tertile 1, n=79; E2 tertile 2, n=83; E2 tertile 3, n=51. PAT T1: ≥2.48  and ≤9.43 mm3; PAT T2: >9.43 and ≤16.02 mm3; PAT T3: >16.02 mm3. CAC indicates coronary artery calcification; EAT, epicardial adipose tissue; E2, estradiol; PAT, paracardial adipose tissue; PAT T1, first tertile of paracardial adipose tissue volume; PAT T2, second tertile of paracardial adipose tissue volume; PAT T3, third tertile of paracardial adipose tissue volume.
See this image and copyright information in PMC

References

    1. Gorodeski GI. Impact of the menopause on the epidemiology and risk factors of coronary artery heart disease in women. Exp Gerontol. 1994;29:357–375. - PubMed
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER III, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee . Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:447–454. - PubMed
    1. Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith SR. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond). 2008;32:949–958. - PMC - PubMed
    1. Abdulnour J, Doucet E, Brochu M, Lavoie JM, Strychar I, Rabasa‐Lhoret R, Prud'homme D. The effect of the menopausal transition on body composition and cardiometabolic risk factors: a Montreal‐Ottawa New Emerging Team group study. Menopause. 2012;19:760–767. - PubMed
    1. Guthrie JR, Dennerstein L, Taffe JR, Lehert P, Burger HG. The menopausal transition: a 9‐year prospective population‐based study. The Melbourne Women's Midlife Health Project. Climacteric. 2004;7:375–389. - PubMed

Publication types

MeSH terms