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Perivascular Adipose Tissue and Coronary Atherosclerosis: from Biology to Imaging Phenoty**

  • Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever, Section Editor)
  • Published:
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Abstract

Purpose of Review

Perivascular adipose tissue (PVAT) has a complex, bidirectional relationship with the vascular wall. In disease states, PVAT secretes pro-inflammatory adipocytokines which may contribute to atherosclerosis. Recent evidence demonstrates that pericoronary adipose tissue (PCAT) may also function as a sensor of coronary inflammation. This review details PVAT biology and its clinical translation to current imaging phenoty**.

Recent Findings

PCAT attenuation derived from routine coronary computed tomography (CT) angiography is a novel noninvasive imaging biomarker of coronary inflammation. Pro-inflammatory cytokines released from the arterial wall diffuse directly into the surrounding PCAT and inhibit adipocyte lipid accumulation in a paracrine manner. This can be detected as an increased PCAT CT attenuation, a metric which associates with high-risk plaque features and independently predicts cardiac mortality. There is also evidence that PCAT attenuation relates to coronary plaque progression and is modified by systemic anti-inflammatory therapies.

Summary

Due to its proximity to the coronary arteries, PCAT has emerged as an important fat depot in cardiovascular research. PCAT CT attenuation has the potential to improve cardiovascular risk stratification, and future clinical studies should examine its role in guiding targeted medical therapy.

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Funding

Dr Nerlekar is supported by a post-doctoral scholarship from the National Heart Foundation and a Robertson Family Research Fellowship. Dr. Dey is supported in part by a National Heart, Lung, and Blood Institute grant 1R01HL133616.

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Authors and Affiliations

  1. Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia

    Andrew Lin, Dennis T. L. Wong & Nitesh Nerlekar

  2. Department of Medicine, Monash University, Clayton, Victoria, Australia

    Andrew Lin, Dennis T. L. Wong & Nitesh Nerlekar

  3. Biomedical Imaging Research Institute, Cedar-Sinai Medical Centre, Los Angeles, CA, USA

    Andrew Lin & Damini Dey

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  1. Andrew Lin
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  2. Damini Dey
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  3. Dennis T. L. Wong
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  4. Nitesh Nerlekar
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Correspondence to Nitesh Nerlekar.

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Andrew Lin, Damini Dey, Dennis T.L. Wong, and Nitesh Nerlekar declare they have no conflict of interest.

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Lin, A., Dey, D., Wong, D.T.L. et al. Perivascular Adipose Tissue and Coronary Atherosclerosis: from Biology to Imaging Phenoty**. Curr Atheroscler Rep 21, 47 (2019). https://doi.org/10.1007/s11883-019-0817-3

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