Relationships between perivascular adipose tissue and vascular wall remodeling: A systematic review and meta-analysis

Background: The association between ectopic fat and vascular stiffness is poorly studied and has never been systematically reviewed. We conducted a systematic review and meta-analysis aimed to systematize current literature and investigate the association of perivascular adipose tissue (PVAT) and the indices of vascular wall remodeling and arterial stiffness, such as pulse wave velocity (PWV), augmentation index (AI), cardio–ankle vascular index (CAVI), endothelium-dependent vasodilation (EDV), and intima–media thickness (IMT). Methods: A systematic literature review was performed according to PRISMA guidelines via searching PubMed, Scopus, and Web of Science databases using specific keywords. Data were extracted from eight studies with 1244 participants that fit the criteria and analyzed using a random-effects model. Results: Our pooled analysis revealed stronger correlations between carotid–femoral pulse wave velocity (cfPWV), AI, and the density of thoracic periaortic adipose tissue ( r = 0.56, p < 0.05, n = 14); carotid extra-media thickness (EMT) and average daily PWV in the aorta ( r = 0.56, p < 0.05, n = 84); and thoracic periaortic fat volume and CAVI ( r = 0.49, p < 0.05, n = 318). Conclusion: Our results demonstrate the association between PVAT and vascular wall remodeling, emphasizing the need for early detection of dysfunctional PVAT as the contributor to higher cardiovascular risk, not only in patients with risk factors and cardiovascular diseases, but also in healthy individuals. (PROSPERO Registration No.: CRD42023443139)