systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.26442/2075082X.2018.4.180111systhiper-569Research ArticleСТАТЬИARTICLESЭпикардиальный жир: новый маркер кардиометаболического риска - новая терапевтическая цель у пациентов с ожирениемEpicardial fat: a new cardiometabolic risk marker, a new therapeutic goal in obese patientsБлиноваН. В.BlinovaN. V.nat-cardio1@yandex.ruЖернаковаЮ. В.ZhernakovaYu. V.juli001@mail.ruАзимоваМ. О.AzimovaM. O.m.azimova@doconcall.ruАзимоваМ. Р.AzimovaM. R.noemail@neicon.ruЧазоваИ. Е.ChazovaI. E.c34h@yandex.ruФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава РоссииРоссияNational Medical Research Center for Cardiology of the Ministry of Health of the Russian FederationRussian Federation2018231220221546669Copyright © Блинова Н.В., Жернакова Ю.В., Азимова М.О., Азимова М.Р., Чазова И.Е., 20222022Блинова Н.В., Жернакова Ю.В., Азимова М.О., Азимова М.Р., Чазова И.Е.Blinova N.V., Zhernakova Y.V., Azimova M.O., Azimova M.R., Chazova I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/569

Эпикардиальный жир (ЭКЖ), позиционируемый как один из факторов риска развития сердечно-сосудистых заболеваний, вызывает большой интерес у исследователей и является актуальным предметом для изучения. В данной статье представлен обзор по влиянию ЭКЖ на сердечно-сосудистую систему и метаболические параметры, новые терапевтические возможности по влиянию на выраженность ЭКЖ. В настоящее время не существует общепринятых методов по измерению выраженности ЭКЖ, в качестве одного из методов предлагается использование трансторакальной эхокардиографии - простого доступного информативного метода

Epicardial fat (EF) is thought to be a cardiovascular risk factor, it has attracted a great interest from researchers and is relevant to study. The article presents a review on EF influence on cardiovascular system and metabolic parameters, as well as new therapeutic approaches to modify EF volume. There are no established methods for EF parameters measurement at present. The use of transthoracic echocardiography which is a simple, accessible, and informative procedure is suggested as one of these methods

эпикардиальный жирожирениекомпьютерно-томографическая визуализация сердцатолщина эпикардиального жирасердечно-сосудистый рискepicardial fatobesitycomputer tomography heart imagingepicardial fat thicknesscardiovascular riskReferencesHubert H.B, Feinleib M, McNamara P.M et al. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67 (5): 968-77.Hubert H.B, Feinleib M, McNamara P.M et al. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67 (5): 968-77.Fox C.S, Massaro J.M, Hoffmann U et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 2007; 116: 39-48.Fox C.S, Massaro J.M, Hoffmann U et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 2007; 116: 39-48.Eckel N, Li Y, Kuxhaus O et al. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses' Health Study): 30 year follow-up from a prospective cohort study. Lancet Diabetes Endocrinol 2018. DOI: 10.1016/S2213-8587(18)30137-2Eckel N, Li Y, Kuxhaus O et al. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses' Health Study): 30 year follow-up from a prospective cohort study. Lancet Diabetes Endocrinol 2018. DOI: 10.1016/S2213-8587(18)30137-2Азимова М.О., Блинова Н.В., Жернакова Ю.В., Чазова И.Е. Ожирение как предиктор сердечно-сосудистых заболеваний: роль локальных жировых депо. Системные гипертензии. 2018; 15 (3): 39-43. DOI: 10.26442/2075-082X_2018.3.39-43Азимова М.О., Блинова Н.В., Жернакова Ю.В., Чазова И.Е. Ожирение как предиктор сердечно-сосудистых заболеваний: роль локальных жировых депо. Системные гипертензии. 2018; 15 (3): 39-43. DOI: 10.26442/2075-082X_2018.3.39-43Sun K, Kusminski C, Scherer P. Adipose tissue remodeling and obesity. J Clin Invest 2011; 121 (6): 2094-101. DOI: 10.1172/JCI45887Sun K, Kusminski C, Scherer P. Adipose tissue remodeling and obesity. J Clin Invest 2011; 121 (6): 2094-101. DOI: 10.1172/JCI45887Hajer G, Haeften T, Visseren F. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J 2008; 29: 2959-71. DOI:10.1093/eurheartj/ehn387Hajer G, Haeften T, Visseren F. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J 2008; 29: 2959-71. DOI:10.1093/eurheartj/ehn387Iacobellis G, Corradi D, Sharma A.M. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005; 2: 536-43. DOI: 10.1038/ncpcardio0319Iacobellis G, Corradi D, Sharma A.M. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005; 2: 536-43. DOI: 10.1038/ncpcardio0319Sacks H.S, Fain J.N. Human epicardial adipose tissue: a review. Am Heart J 2007; 153: 907-17. DOI: 10.1016/j.ahj.2007.03.019Sacks H.S, Fain J.N. Human epicardial adipose tissue: a review. Am Heart J 2007; 153: 907-17. DOI: 10.1016/j.ahj.2007.03.019Rosito G.A, Massaro J.M, Hoffman U et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: The Framingham Heart Study. Circulation 2008; 117: 605-13. DOI: 10.1161/CIRCULATIONAHA.107.743062Rosito G.A, Massaro J.M, Hoffman U et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: The Framingham Heart Study. Circulation 2008; 117: 605-13. DOI: 10.1161/CIRCULATIONAHA.107.743062Mahabadi A.A, Massaro J.M, Rosito G.A et al. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: The Framingham Heart Study. Eur Heart J 2009; 30: 850-6. DOI:10.1093/eurheartj/ehn573Mahabadi A.A, Massaro J.M, Rosito G.A et al. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: The Framingham Heart Study. Eur Heart J 2009; 30: 850-6. DOI:10.1093/eurheartj/ehn573Ding J, Hsu F.C, Harris T.B et al. The association of pericardial fat with incident coronary heart disease. The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 2009; 90: 499-504. DOI: 10.3945/ajcn.2008.27358Ding J, Hsu F.C, Harris T.B et al. The association of pericardial fat with incident coronary heart disease. The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 2009; 90: 499-504. DOI: 10.3945/ajcn.2008.27358Mazurek T, Zhang L.F, Zalewski A et al. Human epicardial adipose tissue is a source of inflammatory markers. Circulation 2003; 108: 2460-6. DOI: 10.1161/01.CIR.0000099542.57313.C5Mazurek T, Zhang L.F, Zalewski A et al. Human epicardial adipose tissue is a source of inflammatory markers. Circulation 2003; 108: 2460-6. DOI: 10.1161/01.CIR.0000099542.57313.C5Hirata Y, Tabata M, Kurobe H et al. Coronary atherosclerosis is associated with macrophage polarization in epicardial adipose tissue. J Am Coll Cardiol 2011; 58: 248-55. DOI: 10.1016/j.jacc.2011.01.048Hirata Y, Tabata M, Kurobe H et al. Coronary atherosclerosis is associated with macrophage polarization in epicardial adipose tissue. J Am Coll Cardiol 2011; 58: 248-55. DOI: 10.1016/j.jacc.2011.01.048Hatem S.N, Sanders P. Epicardial adipose tissue and atrial fibrillation. Cardiovasc Res 2014; 102: 205-13. DOI:10.1093/cvr/cvu045Hatem S.N, Sanders P. Epicardial adipose tissue and atrial fibrillation. Cardiovasc Res 2014; 102: 205-13. DOI:10.1093/cvr/cvu045Chung M.K, Martin D.O, Sprecher D et al. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2001; 104: 2886-91.Chung M.K, Martin D.O, Sprecher D et al. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2001; 104: 2886-91.Aviles R.J, Martin D.O, Apperson-Hansen C et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003; 108: 3006-10. DOI: 10.1161/01.CIR.0000103131.70301.4FAviles R.J, Martin D.O, Apperson-Hansen C et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003; 108: 3006-10. DOI: 10.1161/01.CIR.0000103131.70301.4FMazurek T, Kiliszek M, Kobylecka M et al. Relation of proinflammatory activity of epicardial adipose tissue to the occurrence of atrial fibrillation. Am J Cardiol 2014; 113: 1505-8. DOI: 10.1016/j.amjcard.2014.02.005Mazurek T, Kiliszek M, Kobylecka M et al. Relation of proinflammatory activity of epicardial adipose tissue to the occurrence of atrial fibrillation. Am J Cardiol 2014; 113: 1505-8. DOI: 10.1016/j.amjcard.2014.02.005Arnoldi C.T Ng, Strudwick M, van der Geest R.J et al. Impact of Epicardial Adipose Tissue, Left Ventricular Myocardial Fat Content, and Interstitial Fibrosis on Myocardial Contractile Function. Circ Cardiovasc Imaging 2018; 11: e007372. DOI: 10.1161/CIRCIMAGING.117.007372Arnoldi C.T Ng, Strudwick M, van der Geest R.J et al. Impact of Epicardial Adipose Tissue, Left Ventricular Myocardial Fat Content, and Interstitial Fibrosis on Myocardial Contractile Function. Circ Cardiovasc Imaging 2018; 11: e007372. DOI: 10.1161/CIRCIMAGING.117.007372Corradi D et al. The ventricular epicardial fat is related to the myocardial mass in normal, тischemic and hypertrophic hearts. Cardiovasc Pathol 2004; 13: 313-6. DOI: 10.1016/j.carpath.2004.08.005Corradi D et al. The ventricular epicardial fat is related to the myocardial mass in normal, тischemic and hypertrophic hearts. Cardiovasc Pathol 2004; 13: 313-6. DOI: 10.1016/j.carpath.2004.08.005Iacobellis G, Ribaudo M.C, Zappaterreno A et al. Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol 2004; 94: 1084-7. DOI: 10.1016/j.amjcard.2004.06.075Iacobellis G, Ribaudo M.C, Zappaterreno A et al. Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol 2004; 94: 1084-7. DOI: 10.1016/j.amjcard.2004.06.075Mancio J, Azevedo D, Fragao-Marques et al. Meta-Analysis of Relation of Epicardial Adipose Tissue Volume to Left Atrial Dilation and to Left Ventricular Hypertrophy and Functions. Am J Cardiol 2018. pii: S0002-9149(18)32034-4. DOI: 10.1016/j.amjcard.2018.10.020Mancio J, Azevedo D, Fragao-Marques et al. Meta-Analysis of Relation of Epicardial Adipose Tissue Volume to Left Atrial Dilation and to Left Ventricular Hypertrophy and Functions. Am J Cardiol 2018. pii: S0002-9149(18)32034-4. DOI: 10.1016/j.amjcard.2018.10.020Iacobelis G, Ribaudo M.C, Assael F et al. Echocardiographic Epicardial Adipose Tissue Is Related to Anthropometric and Clinical Parameters of Metabolic Syndrome: A New Indicator of Cardiovascular Risk. J Clin Endocrinol Metab 2003; 88 (11): 5163-8. DOI:10.1210/jc.2003-030698Iacobelis G, Ribaudo M.C, Assael F et al. Echocardiographic Epicardial Adipose Tissue Is Related to Anthropometric and Clinical Parameters of Metabolic Syndrome: A New Indicator of Cardiovascular Risk. J Clin Endocrinol Metab 2003; 88 (11): 5163-8. DOI:10.1210/jc.2003-030698Natale F, Tedesco M.A, Mocerino R et al. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiography 2009; 10: 549-55. DOI: 10.1093/ejechocard/jep002Natale F, Tedesco M.A, Mocerino R et al. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiography 2009; 10: 549-55. DOI: 10.1093/ejechocard/jep002Roever L, Santos Resende E, Lemos Debs Diniz A et al. Epicardial adipose tissue and carotid artery disease. Protocol for systematic review and meta-analysis. Medicine 2018; 97 (17): e0273. DOI: 10.1097/md.0000000000010273Roever L, Santos Resende E, Lemos Debs Diniz A et al. Epicardial adipose tissue and carotid artery disease. Protocol for systematic review and meta-analysis. Medicine 2018; 97 (17): e0273. DOI: 10.1097/md.0000000000010273Sacks H.S, Fain J.N, Cheema P et al. Inflammatory genes in epicardial fat contiguous with coronary atherosclerosis in the metabolic syndrome and type 2 diabetes: changes associated with pioglitazone. Diabetes Care 2011; 34: 730-3. DOI: 10.2337/dc10-2083Sacks H.S, Fain J.N, Cheema P et al. Inflammatory genes in epicardial fat contiguous with coronary atherosclerosis in the metabolic syndrome and type 2 diabetes: changes associated with pioglitazone. Diabetes Care 2011; 34: 730-3. DOI: 10.2337/dc10-2083Distel E, Penot G, Cadoudal T et al. Early induction of a brown-like phenotype by rosiglitazone in the epicardial adipose tissue of fatty Zucker rats. Biochimie 2012; 94: 1660-7. DOI: 10.1016/j.biochi.2012.04.014Distel E, Penot G, Cadoudal T et al. Early induction of a brown-like phenotype by rosiglitazone in the epicardial adipose tissue of fatty Zucker rats. Biochimie 2012; 94: 1660-7. DOI: 10.1016/j.biochi.2012.04.014Iacobellis G, Mohseni M, Bianco S.D et al. Liraglutide Causes Large and Rapid Epicardial Fat Reduction. Obesity 2017; 25: 311-6. DOI: 10.1002/oby.21718Iacobellis G, Mohseni M, Bianco S.D et al. Liraglutide Causes Large and Rapid Epicardial Fat Reduction. Obesity 2017; 25: 311-6. DOI: 10.1002/oby.21718Morano S, Romagnoli E, Filardi T et al. Short-term effects of glucagon-like peptide 1 (GLP-1) receptor agonists on fat distribution in patients with type2 diabetes mellitus: an ultrasonography study. Acta Diabetol 2015; 52: 727-32. DOI: 10.1007/s00592-014-0710-zMorano S, Romagnoli E, Filardi T et al. Short-term effects of glucagon-like peptide 1 (GLP-1) receptor agonists on fat distribution in patients with type2 diabetes mellitus: an ultrasonography study. Acta Diabetol 2015; 52: 727-32. DOI: 10.1007/s00592-014-0710-zLima-Martinez M.M, Paoli M, Rodney M et al. Effect of sitagliptin on epicardial fatthickness in subjects with type 2 diabetes and obesity: a pilotstudy. Endocrine 2016; 51 (3): 448-55. DOI: 10.1007/s12020-015-0710-yLima-Martinez M.M, Paoli M, Rodney M et al. Effect of sitagliptin on epicardial fatthickness in subjects with type 2 diabetes and obesity: a pilotstudy. Endocrine 2016; 51 (3): 448-55. DOI: 10.1007/s12020-015-0710-yPark J.H, Park Y.S, Kim Y.J et al. Effects of statins on the epicardial fat thickness in patients with coronary artery stenosis underwent percutaneous coronary intervention: comparison of atorvastatin with simvastatin/ ezetimibe. J Cardiovasc Ultrasound 2010; 18: 121-6. DOI: 10.4250/jcu.2010.18.4.121Park J.H, Park Y.S, Kim Y.J et al. Effects of statins on the epicardial fat thickness in patients with coronary artery stenosis underwent percutaneous coronary intervention: comparison of atorvastatin with simvastatin/ ezetimibe. J Cardiovasc Ultrasound 2010; 18: 121-6. DOI: 10.4250/jcu.2010.18.4.121Iacobellis G, Assael F, Ribaudo M.C et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003; 11: 304-10. DOI: 10.1038/oby.2003.45Iacobellis G, Assael F, Ribaudo M.C et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003; 11: 304-10. DOI: 10.1038/oby.2003.45Iacobellis G, Willens H.J. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 2009; 22: 1311-9. DOI: 10.1016/j.echo.2009.10.013Iacobellis G, Willens H.J. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 2009; 22: 1311-9. DOI: 10.1016/j.echo.2009.10.013Iacobellis G, Singh N, Wharton S, Sharma A.M. Substantial changes in epicardial fat thickness after weight loss in severely obese subjects. Obesity (Silver Spring) 2008; 16 (7): 1693-7. DOI: 10.1038/oby.2008.251Iacobellis G, Singh N, Wharton S, Sharma A.M. Substantial changes in epicardial fat thickness after weight loss in severely obese subjects. Obesity (Silver Spring) 2008; 16 (7): 1693-7. DOI: 10.1038/oby.2008.251Flüchter S, Lindert A.S, Vos A.M et al. Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging. Obesity 2007; 15: 870-8. DOI: 10.1038/oby.2007.591Flüchter S, Lindert A.S, Vos A.M et al. Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging. Obesity 2007; 15: 870-8. DOI: 10.1038/oby.2007.591

The authors declare that there are no conflicts of interest present.