russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2016-4-89-96russjcardiol-669Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУSUPPORTING A PRACTITIONERМЕТОДЫ ОЦЕНКИ ВИСЦЕРАЛЬНОГО ОЖИРЕНИЯ В КЛИНИЧЕСКОЙ ПРАКТИКЕMETHODS OF VISCERAL OBESITY ASSESSMENT IN CLINICAL PRACTICEЧумаковаГ. А.ChumakovaG. A.

д.м.н., профессор кафедры госпитальной и поликлинической терапии, Барнаул;

в.н.с., Кемерово

Barnaul;

Kemerovo

g.a.chumakova@mail.ruВеселовскаяН. Г.VeselovskayaN. G.

с.н.с., Барнаул;

д.м.н.,  зав. кардиологическим отделением, Кемерово

Barnaul;

Kemerovo

nadezhda100@rambler.ruГБОУ ВПО Алтайский государственный медицинский университет Минздрава России; НИИ комплексных проблем сердечно-сосудистых заболеванийРоссияAltai State Medical University of the Ministry of Health; Research Institute for Complex Issues of Cardiovascular DiseasesRussian FederationКГБУЗ Алтайский краевой кардиологический диспансер; НИИ комплексных проблем сердечно-сосудистых заболеванийРоссияAltai Regional Cardiovascular Dispensary; Research Institute for Complex Issues of Cardiovascular DiseasesRussian Federation20162804201604РОССИЙСКИЙ КАРДИОЛОГИЧЕСКИЙ ЖУРНАЛ8996Copyright © Чумакова Г.А., Веселовская Н.Г., 20162016Чумакова Г.А., Веселовская Н.Г.Chumakova G.A., Veselovskaya N.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/669

Ожирение, прежде всего висцеральное, является хроническим заболеванием с высоким риском кардиометаболических осложнений. Точная диагностика висцерального ожирения (ВО) является непростой задачей, так как большинство методов имеют как достоинства, так и ограничения для их использования. В статье рассматриваются возможности и недостатки антропометрических, ультразвуковых методов, а также магниторезонансной и компьютерной томографии. Предлагается шире использовать наиболее простой и доступный метод прямой диагностики ВО методом эхокардиографии по степени эпикардиального ожирения.

Obesity, especially visceral, is a chronic disorder with high risk of cardiometabolic complications. Precise diagnostics of visceral obesity (VO) is not easy, as most methods have benefits and restrictions for application as well. The article focuses on the opportunities and shortcomings of anthropometric, ultrasound methods, and magnet-resonance and computed tomography. We recommend to have broader application of simple and very much available method of direct VO diagnostics — echocardiography — by the measurement of epicardial fat layer.

висцеральное ожирениеметоды диагностикиvisceral obesitydiagnostical approachesReferencesAmerican Association of Clinical Endocrinologists и American college of Endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract 2014; 20(9): 978-989American Association of Clinical Endocrinologists и American college of Endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract 2014; 20(9): 978-989Guo F, Moellering DR, Garvey WT. The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity. Obesity (Silver Spring) 2014; 22: 110-118.Guo F, Moellering DR, Garvey WT. The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity. Obesity (Silver Spring) 2014; 22: 110-118.Druzhilov MA, Druzhilova OYu, Beteleva YuE, Kuznetsova TYu. Obesity as a cardiovascular risk factor: accent on quality and functional activity of adipose tissue. Russ J Cardiol 2015; 4(120): 111–117. Russian (Дружилов М.А., Дружилова О.Ю., Бетелева Ю.Е., Кузнецова Т.Ю. Ожирение как фактор сердечно-сосудистого риска: акцент на качество и функциональную активность жировой ткани. Российский кардиологический журнал 2015; 4(120): 111–117).Druzhilov MA, Druzhilova OYu, Beteleva YuE, Kuznetsova TYu. Obesity as a cardiovascular risk factor: accent on quality and functional activity of adipose tissue. Russ J Cardiol 2015; 4(120): 111–117. Russian (Дружилов М.А., Дружилова О.Ю., Бетелева Ю.Е., Кузнецова Т.Ю. Ожирение как фактор сердечно-сосудистого риска: акцент на качество и функциональную активность жировой ткани. Российский кардиологический журнал 2015; 4(120): 111–117).Gonzalez-Campoy JM, St. Jeor S, Castorino K, et al. Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by the American Association of Clinical Endocrinologists/The American College of Endocrinology and the Obesity Society. Endocr Pract 2013; 19: 1-82.Gonzalez-Campoy JM, St. Jeor S, Castorino K, et al. Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by the American Association of Clinical Endocrinologists/The American College of Endocrinology and the Obesity Society. Endocr Pract 2013; 19: 1-82.Bessesen, D.H. Evaluation and management of obesity Hanley and Belfus Inc. Philadelphia 2006; 24.Bessesen, D.H. Evaluation and management of obesity Hanley and Belfus Inc. Philadelphia 2006; 24.Klein S, Allison DB, Heymsfield SB, et al. Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention, NAASO, The Obesity Society, the American Society for Nutrition and the American Diabetes Association. Am J Clin Nutr 2007; 85(5): 1197-1202.Klein S, Allison DB, Heymsfield SB, et al. Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention, NAASO, The Obesity Society, the American Society for Nutrition and the American Diabetes Association. Am J Clin Nutr 2007; 85(5): 1197-1202.Druzhilov MA, Beteleva YuE, Kuznetsova TYu. Epicardial adipose tissue thickness – an alternative to waist circumference as a stand-alone or secondary main criterion in metabolic syndrome diagnostics? Russ J Cardiol 2014; 3(107):76–81. Russian (М.А. Дружилов, Ю.Е. Бетелева, Т.Ю. Кузнецова. Толщина эпикардиального жира – альтернатива окружности талии как самостоятельный или второй основной критерий для диагностики метаболического синдрома? Российский кардиологический журнал 2014; 3(107): 76–81).Druzhilov MA, Beteleva YuE, Kuznetsova TYu. Epicardial adipose tissue thickness – an alternative to waist circumference as a stand-alone or secondary main criterion in metabolic syndrome diagnostics? Russ J Cardiol 2014; 3(107):76–81. Russian (М.А. Дружилов, Ю.Е. Бетелева, Т.Ю. Кузнецова. Толщина эпикардиального жира – альтернатива окружности талии как самостоятельный или второй основной критерий для диагностики метаболического синдрома? Российский кардиологический журнал 2014; 3(107): 76–81).National Institutes of Health (NIH). Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report. Washington, D.C: Government Printing Office 1998; 47National Institutes of Health (NIH). Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report. Washington, D.C: Government Printing Office 1998; 47Madeira FB, Silva AA, Veloso HF, et al. Normal weight obesity is associated with metabolic syndrome and insulin resistance in young adults from a middle-income country. PLoS One 2013; 8: e60673.Madeira FB, Silva AA, Veloso HF, et al. Normal weight obesity is associated with metabolic syndrome and insulin resistance in young adults from a middle-income country. PLoS One 2013; 8: e60673.Koning L, Merchant AT, Pogue J. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007;7(28):850-6.Koning L, Merchant AT, Pogue J. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007;7(28):850-6.Coutinho T, Goel K, Corrêa De Sá D, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: Role of "normal weight central obesity". J Am Coll Cardiol 2013; 61: 553-560Coutinho T, Goel K, Corrêa De Sá D, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: Role of "normal weight central obesity". J Am Coll Cardiol 2013; 61: 553-560O'Neill T, Guaraldi G, Orlando G. Combined Use of Waist and Hip Circumference to Identify Abdominally Obese HIV-Infected Patients at Increased Health Risk. PLoS One 2013; 5(8): 625-38.O'Neill T, Guaraldi G, Orlando G. Combined Use of Waist and Hip Circumference to Identify Abdominally Obese HIV-Infected Patients at Increased Health Risk. PLoS One 2013; 5(8): 625-38.Öhman MK, Luo W. Perivascular Visceral Adipose Tissue Induces Atherosclerosis in Apolipoprotein E Deficient. Atherosclerosis 2011 Nov; 219(1): 33–39Öhman MK, Luo W. Perivascular Visceral Adipose Tissue Induces Atherosclerosis in Apolipoprotein E Deficient. Atherosclerosis 2011 Nov; 219(1): 33–39Scherzer R, Shen W, Heymsfield SB. Obesity (Silver Spring) 2011 Feb; 19(2): 283–291.Scherzer R, Shen W, Heymsfield SB. Obesity (Silver Spring) 2011 Feb; 19(2): 283–291.Fluchter S, Haghi D, Dinter D, et al. Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging. Obesity 2007; 15: 870–878.Fluchter S, Haghi D, Dinter D, et al. Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging. Obesity 2007; 15: 870–878.Kuk JL, Church TS, Blair SN. Does measurement site for visceral and abdominal subcutaneous adipose tissue alter associations with the metabolic syndrome? Diabetes Care 2006; 29: 679 - 684.Kuk JL, Church TS, Blair SN. Does measurement site for visceral and abdominal subcutaneous adipose tissue alter associations with the metabolic syndrome? Diabetes Care 2006; 29: 679 - 684.Schlett CL, Massaro JM, Lehman SJ, et al. Novel measurements of periaortic adipose tissue in comparison to anthropometric measures of obesity, and abdominal adipose tissue. Int J Obes 2009; 33: 226-232.Schlett CL, Massaro JM, Lehman SJ, et al. Novel measurements of periaortic adipose tissue in comparison to anthropometric measures of obesity, and abdominal adipose tissue. Int J Obes 2009; 33: 226-232.Fox CS, Massaro JM, Schlett CL, et al. Peri-aortic fat deposition is associated with peripheral arterial disease: the Framingham Heart Study. Circ Cardiovasc Imaging 2010; 3: 515-519.Fox CS, Massaro JM, Schlett CL, et al. Peri-aortic fat deposition is associated with peripheral arterial disease: the Framingham Heart Study. Circ Cardiovasc Imaging 2010; 3: 515-519.Reisin E, Jack AV. Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches. Med Clin North Am 2009; 93: 733–751.Reisin E, Jack AV. Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches. Med Clin North Am 2009; 93: 733–751.Sijens PE, Edens MA, Bakker SJ, Stolk RP. MRI-determined fat content of human liver, pancreas and kidney. World J Gastroenterol 2010; 16: 1993-1998.Sijens PE, Edens MA, Bakker SJ, Stolk RP. MRI-determined fat content of human liver, pancreas and kidney. World J Gastroenterol 2010; 16: 1993-1998.Kelley DE, Slasky BS, Janosky J. Skeletal muscle density: effects of obesity and non-insulin-dependent diabetes mellitus. American Journal of Clinical Nutrition 1991; 54(3): 509-515.Kelley DE, Slasky BS, Janosky J. Skeletal muscle density: effects of obesity and non-insulin-dependent diabetes mellitus. American Journal of Clinical Nutrition 1991; 54(3): 509-515.Karampinos DC, Baum T, Nardo L, et al. Characterization of the regional distribution of skeletal muscle adipose tissue in type 2 diabetes using chemical shift-based water/fat separation. Journal of Magnetic Resonance Imaging 2012; 35(4): 899-907.Karampinos DC, Baum T, Nardo L, et al. Characterization of the regional distribution of skeletal muscle adipose tissue in type 2 diabetes using chemical shift-based water/fat separation. Journal of Magnetic Resonance Imaging 2012; 35(4): 899-907.Wattjes MP, Kley RA, Fischer D. Neuromuscular imaging in inherited muscle diseases. European Radiology. 2010; 20(10): 2447-2460.Wattjes MP, Kley RA, Fischer D. Neuromuscular imaging in inherited muscle diseases. European Radiology. 2010; 20(10): 2447-2460.Chen CL, Cheng YF, Yu CY, et al. Wang CC, Wang SH, et al. Living donor liver transplantation: the Asian perspective. Transplantation 2014; 97 Suppl 8:S3Chen CL, Cheng YF, Yu CY, et al. Wang CC, Wang SH, et al. Living donor liver transplantation: the Asian perspective. Transplantation 2014; 97 Suppl 8:S3Karampinos DC, Baum T, Nardo L, et al. Characterization of the regional distribution of skeletal muscle adipose tissue in type 2 diabetes using chemical shift-based water/fat separation. Journal of Magnetic Resonance Imaging 2012; 35(4): 899-907.Karampinos DC, Baum T, Nardo L, et al. Characterization of the regional distribution of skeletal muscle adipose tissue in type 2 diabetes using chemical shift-based water/fat separation. Journal of Magnetic Resonance Imaging 2012; 35(4): 899-907.Wattjes MP, Kley RA, Fischer D. Neuromuscular imaging in inherited muscle diseases. European Radiology 2010; 20(10): 2447-2460Wattjes MP, Kley RA, Fischer D. Neuromuscular imaging in inherited muscle diseases. European Radiology 2010; 20(10): 2447-2460Browning J.D. Common genetic variants and nonalcoholic fatty liver disease. Clin. Gastroenterol. Hepatol 2013;11:1191-1193.Browning J.D. Common genetic variants and nonalcoholic fatty liver disease. Clin. Gastroenterol. Hepatol 2013;11:1191-1193.World Gastroenterology Organisation Global Guidelines: Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis 2012 [accessed on 17 June 2015]. Online Report. Availableonline:http://www.worldgastroenterology.org/assets/export/userfiles/2012_NASH%20and%20NAFLD_Final_long.pdfWorld Gastroenterology Organisation Global Guidelines: Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis 2012 [accessed on 17 June 2015]. Online Report. Availableonline:http://www.worldgastroenterology.org/assets/export/userfiles/2012_NASH%20and%20NAFLD_Final_long.pdfDey D, Nakazato R, Li D. Epicardial and thoracic fat - Noninvasive measurement and clinical implications. Cardiovasc Diagn Ther 2012 Jun; 2(2): 85-93.Dey D, Nakazato R, Li D. Epicardial and thoracic fat - Noninvasive measurement and clinical implications. Cardiovasc Diagn Ther 2012 Jun; 2(2): 85-93.Bastarrika G, Broncano J, Schoepf UJ, et al. Relationship between coronary artery disease and epicardial adipose tissue quantification at cardiac CT: comparison between automatic volumetric measurement and manual bidimensional estimation. Acad Radiol 2010; 17:727-34Bastarrika G, Broncano J, Schoepf UJ, et al. Relationship between coronary artery disease and epicardial adipose tissue quantification at cardiac CT: comparison between automatic volumetric measurement and manual bidimensional estimation. Acad Radiol 2010; 17:727-34Dagvasumberel M., Shimabukuro M., Nishiuchi T. Gender disparities in the association between epicardial adipose tissue volume and coronary atherosclerosis: A 3-dimensional cardiac computed tomography imaging study in Japanese subjects. Cardiovasc Diabetol 2012; 11: 106-110.Dagvasumberel M., Shimabukuro M., Nishiuchi T. Gender disparities in the association between epicardial adipose tissue volume and coronary atherosclerosis: A 3-dimensional cardiac computed tomography imaging study in Japanese subjects. Cardiovasc Diabetol 2012; 11: 106-110.Gorter PM, Lindert AS, Vos AM, et al. Quantification of epicardial and peri-coronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. Atherosclerosis 2008; 197: 896-903.Gorter PM, Lindert AS, Vos AM, et al. Quantification of epicardial and peri-coronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. Atherosclerosis 2008; 197: 896-903.Flüchter S, Lindert AS, Vos AM, et al. Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging. Obesity 2007;15:870-878.Flüchter S, Lindert AS, Vos AM, et al. Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging. Obesity 2007;15:870-878.Wang TD, Lee WJ, Shih FY, et al. Association of epicardial adipose tissue with coronary atherosclerosis is region-specific and independent of conventional risk factors and intra-abdominal adiposity. Atherosclerosis 2010; 213: 279–287.Wang TD, Lee WJ, Shih FY, et al. Association of epicardial adipose tissue with coronary atherosclerosis is region-specific and independent of conventional risk factors and intra-abdominal adiposity. Atherosclerosis 2010; 213: 279–287.Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003; 11: 304-10.Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003; 11: 304-10.Bertaso AG, Bertol D, Duncan DD. Epicardial Fat: Definition, Measurements and Systematic Review of Main Outcomes. Arq Bras Cardiol 2013; 101(1): 18–28.Bertaso AG, Bertol D, Duncan DD. Epicardial Fat: Definition, Measurements and Systematic Review of Main Outcomes. Arq Bras Cardiol 2013; 101(1): 18–28.Jeong JW, Jeong MH, Yun KH, et al. Echocardiographic epicardial fat thickness and coronary artery disease. Circ J 2007; 4(71): 536–9.Jeong JW, Jeong MH, Yun KH, et al. Echocardiographic epicardial fat thickness and coronary artery disease. Circ J 2007; 4(71): 536–9.Eroglu S, Sade LE, Yildirir A, et al. Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. Nutr Metab Cardiovasc Dis 2009; 3(19): 211-7.Eroglu S, Sade LE, Yildirir A, et al. Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. Nutr Metab Cardiovasc Dis 2009; 3(19): 211-7.Mookadam F, Goel R, Alharthi MS. Epicardial Fat and Its Association with Cardiovascular Risk: A Cross-Sectional Observational Study. Heart Views 2010; 3(11): 103-108.Mookadam F, Goel R, Alharthi MS. Epicardial Fat and Its Association with Cardiovascular Risk: A Cross-Sectional Observational Study. Heart Views 2010; 3(11): 103-108.Pierdomenico SD, Pierdomenico AM. Epicardial Adipose Tissue and Metabolic Syndrome in Hypertensive Patients With Normal Body Weight and Waist Circumference. Am J Hypertens 2011; 24: 1245-1249.Pierdomenico SD, Pierdomenico AM. Epicardial Adipose Tissue and Metabolic Syndrome in Hypertensive Patients With Normal Body Weight and Waist Circumference. Am J Hypertens 2011; 24: 1245-1249.Iacobellis G, Willens HJ. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 2009; 22: 1311-9.Iacobellis G, Willens HJ. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 2009; 22: 1311-9.Mustelie JV, Rego JO, Gonzales AG, et al. Echocardiographic parameters of epicardial fat deposition and its relation to coronary artery disease . Arq Bras Cardiol 2011; 2(97): 122-129.Mustelie JV, Rego JO, Gonzales AG, et al. Echocardiographic parameters of epicardial fat deposition and its relation to coronary artery disease . Arq Bras Cardiol 2011; 2(97): 122-129.Chumakova GA, Veselovskaya NG, Kozarenko AA, et al. Epicardial adipose depot: morphology, diagnostics, clinical value. Serdtze 2011; 10(3): 143–147. Russian (Чумакова Г.А., Веселовская Н.Г., Козаренко А.А. и др. Эпикардиальное жировое депо: морфология, диагностика, клиническое значение. Сердце 2011; 3: 143-147).Chumakova GA, Veselovskaya NG, Kozarenko AA, et al. Epicardial adipose depot: morphology, diagnostics, clinical value. Serdtze 2011; 10(3): 143–147. Russian (Чумакова Г.А., Веселовская Н.Г., Козаренко А.А. и др. Эпикардиальное жировое депо: морфология, диагностика, клиническое значение. Сердце 2011; 3: 143-147).Kim HM, Kim KJ, Lee HJ et al. Epicardial adipose tissue thickness is an indicator for coronary artery stenosis in asymptomatic type 2 diabetic patients: its assessment by cardiac magnetic resonance. Cardiovasc Diabetol 2012; 11: 83-86.Kim HM, Kim KJ, Lee HJ et al. Epicardial adipose tissue thickness is an indicator for coronary artery stenosis in asymptomatic type 2 diabetic patients: its assessment by cardiac magnetic resonance. Cardiovasc Diabetol 2012; 11: 83-86.Iacobellis G, Sharma AM. Adiposity of the heart. Ann Intern Med 2006; 145: 554-555.Iacobellis G, Sharma AM. Adiposity of the heart. Ann Intern Med 2006; 145: 554-555.Granér M, Siren R, Nyman K et al. Cardiac steatosis associates with visceral obesity in nondiabetic obese men. J Clin Endocrinol Metab 2013; 3(98): 1189-97.Granér M, Siren R, Nyman K et al. Cardiac steatosis associates with visceral obesity in nondiabetic obese men. J Clin Endocrinol Metab 2013; 3(98): 1189-97.Malavazos AE, Di Leo G, Secchi F. Relation of echocardiographic epicardial fat thickness and myocardial fat. Am J Cardiol 2010; 105(12): 1831-5.Malavazos AE, Di Leo G, Secchi F. Relation of echocardiographic epicardial fat thickness and myocardial fat. Am J Cardiol 2010; 105(12): 1831-5.Chumakova GA, Veselovskaya NG, Gritzenko OV, et al. Epicardial fat as a possible marker of the metabolic syndrome. Kardiosomatika 2012; 4: 38-43. Russian (Чумакова Г.А., Веселовская Н.Г., Гриценко О.В. и др. Эпикардиальное ожирение как возможный маркер метаболического синдрома. Кардиосоматика 2012; 4: 38-43).Chumakova GA, Veselovskaya NG, Gritzenko OV, et al. Epicardial fat as a possible marker of the metabolic syndrome. Kardiosomatika 2012; 4: 38-43. Russian (Чумакова Г.А., Веселовская Н.Г., Гриценко О.В. и др. Эпикардиальное ожирение как возможный маркер метаболического синдрома. Кардиосоматика 2012; 4: 38-43).Nikaeen, F. The association between epicardial fat thickness in echocardiography and coronary restenosis in drug eluting stents ARYA. Atheroscler 2011; 1(7): 11–17.Nikaeen, F. The association between epicardial fat thickness in echocardiography and coronary restenosis in drug eluting stents ARYA. Atheroscler 2011; 1(7): 11–17.Greif M, Becker A, Ziegler F, et al. Pericardial adipose tissue determined by dual source CT is a risk factor for coronary atherosclerosis . Arterioscler Thromb Vasc Biol 2009; 5(29): 781–786.Greif M, Becker A, Ziegler F, et al. Pericardial adipose tissue determined by dual source CT is a risk factor for coronary atherosclerosis . Arterioscler Thromb Vasc Biol 2009; 5(29): 781–786.

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