Perivascular adipose tissue as a source of therapeutic targets and clinical biomarkers

Abstract

Obesity is a modifiable cardiovascular risk factor, but adipose tissue (AT) depots in humans are anatomically, histologically, and functionally heterogeneous. For example, visceral AT is a pro-atherogenic secretory AT depot, while subcutaneous AT represents a more classical energy storage depot. Perivascular adipose tissue (PVAT) regulates vascular biology via paracrine cross-talk signals. In this position paper, the state-of-the-art knowledge of various AT depots is reviewed providing a consensus definition of PVAT around the coronary arteries, as the AT surrounding the artery up to a distance from its outer wall equal to the luminal diameter of the artery. Special focus is given to the interactions between PVAT and the vascular wall that render PVAT a potential therapeutic target in cardiovascular diseases. This Clinical Consensus Statement also discusses the role of PVAT as a clinically relevant source of diagnostic and prognostic biomarkers of vascular function, which may guide precision medicine in atherosclerosis, hypertension, heart failure, and other cardiovascular diseases. In this article, its role as a ‘biosensor’ of vascular inflammation is highlighted with description of recent imaging technologies that visualize PVAT in clinical practice, allowing non-invasive quantification of coronary inflammation and the related residual cardiovascular inflammatory risk, guiding deployment of therapeutic interventions. Finally, the current and future clinical applicability of artificial intelligence and machine learning technologies is reviewed that integrate PVAT information into prognostic models to provide clinically meaningful information in primary and secondary prevention.

L’Équilibre Périlleux: Mental Stress and Inflammation in Women

“…FAI is a metric derived from coronary computed tomography angiography that measures the balance between lipids and water within perivascular adipose tissue. 3 This novel imaging biomarker captures pericoronary inflammation, thus, improving the detection of lesion-specific ischemia and vulnerable plaques beyond the detection of stenosis. FAI provides incremental prognostic value for MACE prediction, potentially enhancing the role of computed tomography angiography in cardiovascular risk stratification.…”

“…FAI provides incremental prognostic value for MACE prediction, potentially enhancing the role of computed tomography angiography in cardiovascular risk stratification. 3 In addition, an important link has recently been evidenced between SNA, FAI, and high-risk coronary plaque features, 4 as patients with heightened SNA were more likely to display augmented pericoronary inflammation and high-risk coronary plaque features, all of which were associated with an increased risk of MACE. Yet, it remained unknown whether the interplay between SNA, pericoronary inflammation, and coronary plaque vulnerability is influenced by sex.…”

Cardiovascular Significance and Genetics of Epicardial and Pericardial Adiposity

“…It has been conjectured that local secretion of inflammatory factors could be mediating these associations and that cardiovascular risk may be specific to EPAT. The current study 3 published in JAMA Cardiology provides new insights into this question by quantifying EPAT by cardiac magnetic resonance imaging in 44 475 individuals in the UK Biobank and correlating these measurements to abdominal VAT previously quantified in 38 527 of the same individuals. Similar to previous smaller studies, EPAT as a continuous measure was associated with both prevalent and incident type 2 diabetes, heart failure, coronary disease, and atrial fibrillation.…”

“…1 The combination of epicardial and pericardial adipose tissue (EPAT) comprises 2 adjacent adipose tissue compartments: epicardial adipose tissue (EAT) between the visceral pericardium and myocardium and pericardial adipose tissue (PAT) external to the parietal pericardium. 3 In addition to the ectopic location of EPAT within the thoracic cavity, the vascular supply of EAT derives from branches of the coronary arteries similarly to the myocardium, which is in immediate proximity to EAT with no separating fascia. 4 EAT displays features of brownlike or beige adipose tissue and has been hypothesized to have a cardioprotective role via thermogeneration and supply of free fatty acids.…”

What’s VAT All About—The Clue Is in the Genetics

“…VAT contains small and poorly differentiated adipocytes, is more vascular, contains more inflammatory cells, and has higher adipokine secretion compared with SAT . These proinflammatory properties are thought to drive the link between VAT accumulation and cardiometabolic disease, dyslipidemia, and atherosclerosis.…”