Cardiovascular Significance and Genetics of Epicardial and Pericardial Adiposity

Importance Epicardial and pericardial adipose tissue (EPAT) has been associated with cardiovascular diseases such as atrial fibrillation or flutter (AF) and coronary artery disease (CAD), but studies have been limited in sample size or drawn from selected populations. It has been suggested that the association between EPAT and cardiovascular disease could be mediated by local or paracrine effects. Objective To evaluate the association of EPAT with prevalent and incident cardiovascular disease and to elucidate the genetic basis of EPAT in a large population cohort. Design, Setting, and Participants A deep learning model was trained to quantify EPAT area from 4-chamber magnetic resonance images using semantic segmentation. Cross-sectional and prospective cardiovascular disease associations were evaluated, controlling for sex and age. Prospective associations were additionally controlled for abdominal visceral adipose tissue (VAT) volumes. A genome-wide association study was performed, and a polygenic score (PGS) for EPAT was examined in independent FinnGen cohort study participants. Data analyses were conducted from March 2022 to December 2023. Exposures The primary exposures were magnetic resonance imaging–derived continuous measurements of epicardial and pericardial adipose tissue area and visceral adipose tissue volume. Main Outcomes and Measures Prevalent and incident CAD, AF, heart failure (HF), stroke, and type 2 diabetes (T2D). Results After exclusions, this study included 44 475 participants (mean [SD] age, 64.1 [7.7] years; 22 972 female [51.7%]) from the UK Biobank. Cross-sectional and prospective cardiovascular disease associations were evaluated for a mean (SD) of 3.2 (1.5) years of follow-up. Prospective associations were additionally controlled for abdominal VAT volumes for 38 527 participants. A PGS for EPAT was examined in 453 733 independent FinnGen cohort study participants. EPAT was positively associated with male sex (β = +0.78 SD in EPAT; P < 3 × 10 −324 ), age (Pearson r = 0.15; P = 9.3 × 10 −229 ), body mass index (Pearson r = 0.47; P < 3 × 10 −324 ), and VAT (Pearson r = 0.72; P < 3 × 10 −324 ). EPAT was more elevated in prevalent HF (β = +0.46 SD units) and T2D (β = +0.56) than in CAD (β = +0.23) or AF (β = +0.18). EPAT was associated with incident HF (hazard ratio [HR], 1.29 per +1 SD in EPAT; 95% CI, 1.17-1.43), T2D (HR, 1.63; 95% CI, 1.51-1.76), and CAD (HR, 1.19; 95% CI, 1.11-1.28). However, the associations were no longer significant when controlling for VAT. Seven genetic loci were identified for EPAT, implicating transcriptional regulators of adipocyte morphology and brown adipogenesis ( EBF1 , EBF2 , and CEBPA ) and regulators of visceral adiposity ( WARS2 and TRIB2 ). The EPAT PGS was associated with T2D (odds ratio [OR], 1.06; 95% CI, 1.05-1.07; P =3.6 × 10 −44 ), HF (OR, 1.05; 95% CI, 1.04-1.06; P =4.8 × 10 −15 ), CAD (OR, 1.04; 95% CI, 1.03-1.05; P =1.4 × 10 −17 ), AF (OR, 1.04; 95% CI, 1.03-1.06; P =7.6 × 10 −12 ), and stroke in FinnGen (OR, 1.02; 95% CI, 1.01-1.03; P =3.5 × 10 −3 ) per 1 SD in PGS. Conclusions and Relevance Results of this cohort study suggest that epicardial and pericardial adiposity was associated with incident cardiovascular diseases, but this may largely reflect a metabolically unhealthy adiposity phenotype similar to abdominal visceral adiposity.