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Mangili LC. Study of the association of pericardial fat determined by computed tomography with the presence of subclinical coronary atherosclerosis in patients with familial hypercholesterolemia [thesis]. São Paulo: “Faculdade de Medicina, Universidade de São Paulo”; 2016. Familial hypercholesterolemia (FH) is a disease caused by a group of genetic mutations resulting in high blood cholesterol and elevated prevalence of subclinical atherosclerosis and early coronary events. Although high cholesterol is the driving cause of atherosclerosis in FH, the course of the latter is variable and is affected by other risk factors. Pericardial fat (PF) is a visceral fat compartment that is associated to the presence of subclinical atherosclerosis in non-FH populations. The present study sought to determine the association of PF with the presence and extent of subclinical coronary atherosclerosis in FH subjects. Ninety-seven patients with clinical diagnosis of FH, genetically confirmed in 67%, were submitted to coronary tomography angiography and coronary artery calcium (CAC) quantification. The presence of plaques, luminal stenosis >50%, CAC>0, CAC percentile above 75 were evaluated. In order to evaluate the extent and severity of subclinical atherosclerosis, the CAC scores, Segment-Involvement Score (SIS) and Segment-Stenosis Score (SSS) were also measured. Pericardial fat volumes were measured by semi automated method and divided in two compartments: epicardial fat (located inside the pericardial sac) and mediastinal fat (located outside pericardial sac). Logistic regression and linear models tested the association of PF volumes with subclinical coronary atherosclerosis. Patients were predominantly female, with mean age of 45 (±13) years. Coronary plaques and CAC were found respectively in 47.4% and 45.4% of patients. Age, total cholesterol, LDL-C, HDL-C, apolipoproteins A-I and B, the presence of Achilles xanthomas and creatinine clearance were associated with subclinical coronary atherosclerosis in univariate analysis. PF volumes were associated with the presence of metabolic syndrome, hypertension age, BMI, abdominal circumference nonHDL-cholesterol triglycerides and fasting glucose. On multivariate analysis in models adjusted for age, sex, smoking, HDL-C, LDL-C, abdominal circumference, metabolic syndrome and previous statin use epicardial fat was independently associated with CAC > 75 percentile, and was directly proportional to the intensity of CAC, SSS and SIS. In conclusion, epicardial fat was independently associated with a greater extension and severity of subclinical atherosclerosis in FH patients. Descriptors: Multidetector Computed Tomography; Pericardium; Adipose Tissue; Atherosclerosis; Coronary Stenosis; Familial Hypercholesterolemia; Calcium; Coronary Artery Disease; Cholesterol; Risk Factors

Avaliação da associação da gordura pericárdica medida pela tomografia computadorizada com a presença de aterosclerose coronária subclínica em pacientes com hipercolesterolemia familiar