Statins Reduce Epicardial Adipose Tissue Attenuation Independent of Lipid Lowering: A Potential Pleiotropic Effect
Open accessAbstract
Background High epicardial adipose tissue (EAT) attenuation (Hounsfield units [ HUs] ) on computed tomography is considered a marker of inflammation and is associated with an increased risk of cardiovascular events. Statins reduce the volume of EAT , but it is unknown whether they affect EAT HUs . Methods and Results We reviewed the chest computed tomographic scans of 420 postmenopausal women randomized to either 80 mg of atorvastatin or 40 mg of pravastatin daily and rescanned after 1 year to measure change in coronary artery calcium score. EAT HUs were measured near the proximal right coronary artery and remote from any area of coronary artery calcium. Computed tomographic images were also queried for subcutaneous adipose tissue (SubQ) attenuation ( HUs ) change over time. The mean patients' age was 65±6 years. The baseline EAT HU value was higher than the SubQ HU value (-89.4±24.0 HU versus -123.3±30.4 HU ; P<0.001). The EAT HU value decreased significantly in the entire cohort (-5.4±29.7 HU [-6% change]; P<0.001), but equally in the patients given atorvastatin and pravastatin (-6.35+31 HU and -4.55+28 HU ; P=0.55). EAT HU change was not associated with change in total cholesterol, low-density lipoprotein cholesterol, coronary artery calcium, and EAT volume (all P=not significant). Change in high-density lipoprotein cholesterol was marginally associated with EAT HU change ( P=0.07). Statin treatment did not induce a change in SubQ HUs . Conclusions Statins induced a decrease in EAT HUs over time, independent of intensity of low-density lipoprotein cholesterol lowering. The positive effect on EAT and the neutral effect on SubQ suggest that statins induced a decrease in metabolic activity in EAT by reduction in cellularity, vascularity, or inflammation. The clinical significance of the observed change in EAT HUs remains to be demonstrated.
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Statins decrease EAT attenuation at CCT, a marker of inflammation, independently of LDL-cholesterol lowering intensity, but have a neutral effect on subcutaneous fat.
“In a more recent study, statins induced over time and independently of intensity of LDL-cholesterol lowering, a decrease in the attenuation of EAT at CCT considered a marker of inflammation, but a neutral effect on subcutaneous fat [151].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [151]
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- Authors
- Raggi, P., Gadiyaram, V., Zhang, C., Chen, Z., Lopaschuk, G., & Stillman, A. E.
- Affiliations
- University of Alberta (CA)
- Emory University (US)
- Corresponding author
- Raggi, Paolo
- Venue
- Journal of the American Heart Association
- Published
- 2019-06-18
- Volume
- 8
- Issue
- 12
- Pages
- e013104-e013104
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC6645620
- OpenAlex
- W2949846441
- Cited by
- 113
- References
- 42
- Citations by year
- 2026: 7 · 2025: 20 · 2024: 11 · 2023: 19 · 2022: 24 · 2021: 19 · 2020: 12 · 2019: 1
- FWCI
- 10.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- epicardial adipose tissue, statins, atorvastatin, pravastatin, Hounsfield units, subcutaneous adipose tissue, coronary artery calcium, HDL cholesterol, inflammation, postmenopausal women, pleiotropy, lipid lowering
- MeSH terms
- Atorvastatin, Adipose Tissue, Aged, Cholesterol, Female, Humans, Middle Aged, Organ Size, Pericardium, Tomography, X-Ray Computed, Cohort Studies, Pravastatin, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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