Epicardial adipose tissue predicts incident cardiovascular disease and mortality in patients with type 2 diabetes

Abstract

Background Cardiac fat is a cardiovascular biomarker but its importance in patients with type 2 diabetes is not clear. The aim was to evaluate the predictive potential of epicardial (EAT), pericardial (PAT) and total cardiac (CAT) fat in type 2 diabetes and elucidate sex differences. Methods EAT and PAT were measured by echocardiography in 1030 patients with type 2 diabetes. Follow-up was performed through national registries. The end-point was the composite of incident cardiovascular disease (CVD) and all-cause mortality. Analyses were unadjusted (model 1), adjusted for age and sex (model 2), plus systolic blood pressure, body mass index (BMI), low-density lipoprotein (LDL), smoking, diabetes duration and glycated hemoglobin (HbA 1c ) (model 3). Results Median follow-up was 4.7 years and 248 patients (191 men vs. 57 women) experienced the composite end-point. Patients with high EAT (> median level) had increased risk of the composite end-point in model 1 [Hazard ratio (HR): 1.46 (1.13; 1.88), p = 0.004], model 2 [HR: 1.31 (1.01; 1.69), p = 0.038], and borderline in model 3 [HR: 1.32 (0.99; 1.77), p = 0.058]. For men, but not women, high EAT was associated with a 41% increased risk of CVD and mortality in model 3 ( p = 0.041). Net reclassification index improved when high EAT was added to model 3 (19.6%, p = 0.035). PAT or CAT were not associated with the end-point. Conclusion High levels of EAT were associated with the composite of incident CVD and mortality in patients with type 2 diabetes, particularly in men, after adjusting for CVD risk factors. EAT modestly improved risk prediction over CVD risk factors.

Relation of cardiac adipose tissue to coronary calcification and myocardial microvascular function in type 1 and type 2 diabetes

“…as a risk marker [1]. High levels of epicardial adipose tissue have been associated with incident cardiovascular disease and mortality in persons (particularly men) with type 2 diabetes in our previous study [2] and was associated with increased risk of coronary artery disease in persons with a high risk of cardiovascular disease, of whom 45% had type 2 diabetes [3]. An increased epicardial adipose tissue volume has also been demonstrated to be an important determinant of atrial fibrillation recurrence following electrical cardioversion or catheter ablation [4] and to correlate with ventricular tachycardia recurrence after catheter ablation in persons undergoing ventricular tachycardia ablation [5].…”

Pericardial fat and its influence on cardiac diastolic function

“…In addition, Yang et al showed an increased EAT burden in pre-diabetic and diabetic subjects, compared to normoglycemic subjects [ 23 ]. Also, Christensen et al found that high levels of EAT were associated with the composite of incident CVD and mortality in subjects with T2DM [ 24 ]. EAT may possibly play a more central role in the development of asymptomatic diastolic cardiac dysfunction than previously assumed, underlining the importance of a better understanding of the relationship between EAT and early changes in cardiac diastolic function.…”

Epicardial adipose tissue thickness is not associated with adverse cardiovascular events in patients undergoing haemodialysis

“…In addition to its correlation with left ventricular diastolic function 23 , EAT thickness was high in several cardiac diseases, such as coronary artery disease and chronic heart failure 18,24,25 . EAT thickness was reported to be a useful predictor of clinical outcomes and provided incremental prognostic value over traditional CV risk factors [26][27][28] . Christensen et al demonstrated that high levels of EAT were associated with the composite of incident CV diseases and mortality in patients with type 2 diabetes 26 .…”

“…EAT thickness was reported to be a useful predictor of clinical outcomes and provided incremental prognostic value over traditional CV risk factors [26][27][28] . Christensen et al demonstrated that high levels of EAT were associated with the composite of incident CV diseases and mortality in patients with type 2 diabetes 26 . In contrast to Christensen's patients with homogeneous disease, our HD patients had various different pathologies resulting in ESRD and a wide LVEF range (32-80%), indicating inhomogeneous left ventricular systolic function.…”