Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery

<div><p>Background</p><p>Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown.</p><p>Methods</p><p>Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery (non-CABG).</p><p>Results</p><p>In men, EATV, EATV index (EATV/body surface area) and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP) and type 2 diabetes mellitus (Corrected R² = 0.262, p < 0.0001), while in women, type 2 diabetes mellitus is a single strong predictor for CABG, excluding EATV Index (Corrected R² = 0.266, p = 0.005).</p><p>Conclusions</p><p>Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.</p></div

Univariate analysis to estimate operation of CABG.

<p>Univariate analysis to estimate operation of CABG.</p

Plasma brain natriuretic peptide levels are elevated in patients with cancer - Fig 4

<p>A. Relationship between the BNP and creatinine levels in the patients with and without cancer. In the non-cancer patients, there was a significant correlation between the BNP and creatinine levels, but there was no correlation between the BNP and creatinine levels in the cancer patients. B. Relationship between the BNP and age in the patients with and without cancer. In the non-cancer patients, there was a significant correlation between the BNP level and age, but that correlation was not observed in the cancer patients. C. Relationship between the BNP and body mass index in the patients with and without cancer. There was no significant correlation between the BNP levels and body mass index in either the patients with cancer or those without.</p

General characteristics of studied patients.

<p>General characteristics of studied patients.</p

Multivariate analysis to estimate operation of CABG.

<p>Multivariate analysis to estimate operation of CABG.</p

In 28 cured patients with solid cancers who underwent a radical surgery, the plasma BNP levels significantly decreased after the surgery (left panel, closed circles) (*p<0.01 vs the value before surgery).

<p>On the other hand, in 7 relapsed or insufficiently treated patients with solid cancers, the plasma BNP levels did not change after the surgery (left panel, open circles). In 13 patients with hematological cancers, the plasma BNP levels tended to decrease after the chemotherapy, but it did not reach a statistical significance.</p

Patient characteristics.

<p>Patient characteristics.</p

Multiple regression analysis of the BNP levels and potential associated factors in patients without cancer.

<p>Multiple regression analysis of the BNP levels and potential associated factors in patients without cancer.</p

Hypothesized relationship between cancer and the BNP level.

<p>In the tumor microenvironment, inflammatory cells, including macrophages, produce various cytokines in response to tumor cells and tissue necrosis. In cardiomyocytes, BNP synthesis has been shown to be upregulated at the transcriptional level by inflammatory cytokines. Based on these previous findings and our present study, we hypothesized that the production of BNP might be increased in cancer patients by cancer-related inflammation independent of the cardiac function, renal function, and age.</p

Relationship between BNP and CRP in patients with and without cancer.

<p>In non-cancer patients, there was no significant correlation between BNP and CRP levels, but there was a significant positive correlation between BNP and CRP levels in cancer patients.</p