Sex-specific association of epicardial adipose tissue with coronary artery disease in an Indian cohort: a cross-sectional study

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Abstract Background Epicardial adipose tissue (EAT) plays an important role in the pathogenesis of coronary artery disease (CAD). The correlation of EAT volume with CAD or its risk factors, especially the sex-specific correlation, has not been fully characterized. Such a knowledge gap was even larger in the South Asian population given the scarcity of ethnic-specific data. This study intended to evaluate the sex-specific relationship between EAT volume and CAD or its risk factors in an Indian cohort. Methods The retrospective study included 950 subjects who underwent coronary computed tomography angiography (CCTA) from 2013 to 2016 at Sir Ganga Ram Hospital in India. The EAT volume and CAD status were examined. Values of CAD risk factors were documented for the study subjects, including age, sex, body mass index (BMI), smoking, hypertension, diabetes mellitus, family history of CAD, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). In a sex-specific fashion, the generalized additive model and multivariable logistic regression analyses were applied to assess the correlation between EAT volume and CAD or its risk factors. The two-piecewise linear regression model was applied to identify the inflection point for the nonlinear correlations. Results In the 950 subjects, EAT volume was larger in men than in women (67.66 ± 31.83 (n=623) vs 61.93 ± 28.90 (n=327); P = 0.007). After adjusting for confounders, a nonlinear relationship was detected between EAT volume and CAD in the overall subjects and men, but not in women. The inflection point for men was 90ml. The effect sizes and the confidence intervals of EAT volume on CAD were larger when EAT volume was < 90ml. Moreover, we found a linear correlation between EAT volume and BMI in men of the current cohort. In multivariable analysis, either as a continuous or a categorized variable, EAT volume was significantly associated with CAD and BMI by crude, partially adjusted-, and fully adjusted-models in overall subjects and men. Every 1-SD (31.8ml) increase in EAT of men was associated with a higher risk of CAD (odds ratio (OR): 1.76; 95% CI: 1.36 to 2.28; p < 0.00001) by a fully adjusted model. However, EAT volume was not associated with other risk factors. In women of this cohort, EAT volume was not associated with CAD. Interaction analysis indicated BMI influenced the EAT and CAD association specifically in men. EAT volume and CAD showed a stronger association in men with a BMI < 30 kg/m 2 than ≥ 30 kg/m 2 (Interaction P=0.0381). Conclusion EAT volume, an indicator of organ obesity, was positively and independently correlated with CAD in men of the current Indian cohort. In the male subjects, the correlation of EAT volume with CAD was nonlinear, and with BMI was linear. EAT and CAD showed a stronger association in men with EAT volume less than 90 ml or BMI less than 30 kg/m 2 . In women of the current cohort, EAT was not associated with CAD and investigated risk factors, suggesting sex-specific effects of EAT volume on cardiovascular diseases.

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