Epicardial adipose tissue is an independent marker of cardiovascular risk in HIV-infected patients

AIDS. 2011 Jun 1;25(9):1199-205. doi: 10.1097/QAD.0b013e3283474b9f.


Background: Epicardial adipose tissue (EAT) is increased in HIV-infected patients. The aim of this study was to evaluate the association between EAT and coronary artery calcium (CAC) a marker of atherosclerosis; furthermore, we investigated the association of EAT with HIV infection, antiretroviral therapy (ART), and lipodystrophy.

Methods: This was a cross-sectional study of 876 consecutive HIV-infected ART experienced patients. Patients underwent CAC imaging with multidetector computed tomography (CT) for atherosclerosis screening and risk of cardiovascular events (CAC score >100); EAT was measured in the same CT images. Factors independently associated with EAT were explored in a multivariable backward stepwise linear regression analysis. Multivariable logistic regression was used to evaluate the association of EAT and CAC score greater than 100.

Results: Patients' mean age was 47.2 ± 8 years, 68% were men. EAT was associated with central fat accumulation and mixed lipodystrophy phenotypes. Factors independently associated with EAT were: age [β = 0.6, confidence interval (CI) 0.2-1.0], male sex (β = 6.6, CI 0.5-12.7), visceral adipose tissue (β = 0.12, CI 0.08-0.17), waist circumference (β = 0.7, CI 0.04-1.3), current CD4⁺ (β = 0.6, CI 0.1-1.2, per 50 cells), total cholesterol (β = 0.1, CI 0.02-0.15), and cumulative exposure to ART (months) (β = 0.05, CI 0.00-0.11). EAT (per 10 cm³) was associated with CAC greater than 100 (odds ratio = 1.10, CI 1.02-1.19) after adjustment for age, male sex, and diabetes.

Conclusion: We showed an association between EAT and central fat accumulation and mixed form lipodystrophy phenotypes as well as traditional risk factors for atherosclerosis. EAT may be a useful marker of cardiovascular risk as shown by its association with CAC greater than 100.

MeSH terms

  • Adipose Tissue / diagnostic imaging
  • Adipose Tissue / pathology*
  • Adipose Tissue / virology
  • Anti-Retroviral Agents / therapeutic use
  • Biomarkers / analysis
  • Calcium / analysis
  • Cardiovascular Diseases / complications*
  • Coronary Artery Disease / complications
  • Cross-Sectional Studies
  • Female
  • HIV Infections / diagnostic imaging
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • HIV-Associated Lipodystrophy Syndrome / complications*
  • HIV-Associated Lipodystrophy Syndrome / diagnostic imaging
  • HIV-Associated Lipodystrophy Syndrome / virology
  • Humans
  • Male
  • Middle Aged
  • Pericardium / pathology*
  • Risk Factors
  • Tomography, X-Ray Computed


  • Anti-Retroviral Agents
  • Biomarkers
  • Calcium