Epicardial adipose tissue volume and coronary calcification among people living with diabetes: a cross-sectional study

Abstract

Background Epicardial adipose tissue (EAT) has anatomic and functional proximity to the heart and is considered a novel diagnostic marker and therapeutic target in cardiometabolic diseases. The aim of this study was to evaluate whether EAT volume was associated with coronary artery calcification (CAC) in people living with diabetes, independently of confounding factors.Methods We included all consecutive patients with diabetes whose EAT volume and CAC score were measured using computed tomography between January 1, 2019 and September 30, 2020 in the Department of Diabetology-Endocrinology-Nutrition at Avicenne Hospital, France. Determinants of EAT volume and a CAC score ≥ 100 Agatston units (AU) were evaluated.Results The study population comprised 409 patients (218 men). Mean (± standard deviation) age was 57 ± 12 years, and 318, 56 and 35, had type 2 (T2D), type 1 (T1D), or another type of diabetes, respectively. Mean body mass index (BMI) was 29 ± 6 kg/m², mean AET volume 93 ± 38 cm3. EAT volume was positively correlated with age, BMI, pack-year smoking history and triglyceridaemia, but negatively correlated with HDL-cholesterol level. Furthermore, it was lower in people with retinopathy, but higher in men, in Caucasian people, in patients on antihypertensive and lipid-lowering medication, in people with nephropathy, and finally in individuals with a CAC ≥ 100 AU (CAC < 100 vs CAC ≥ 100: 89 ± 35 vs 109 ± 41 cm3, respectively, p < 0.05). In addition to EAT volume, other determinants of CAC ≥ 100 AU (n = 89, 22%) were age, T2D, ethnicity, antihypertensive and lipid-lowering medication, cumulative tobacco consumption, retinopathy, macular edema and macrovascular disease. Multivariable analysis considering all these determinants as well as gender and BMI, showed that EAT volume was independently associated with CAC ≥ 100 AU (per 10 cm3 increase: OR 1.11 [1.02–1.20]).Conclusions EAT volume was independently associated with CAC. As it may play a role in coronary atherosclerosis in patients with diabetes, reducing EAT volume through physical exercise, improved diet and pharmaceutical interventions may improve future cardiovascular risk outcomes in this population.

Adverse association of epicardial adipose tissue accumulation with cardiac function and atrioventricular coupling in postmenopausal women assessed by cardiac magnetic resonance imaging

“…As our correlation analyses showed, age and EAT were both independent factors that inversely correlated with LV-GLS and LA strains. Several previous studies also found a strong relation between age and EAT (14,33). In the study by de Vos et al age-adjusted regression analyses showed that EAT was positively related to weight, BMI, waist circumference, waist-to-hip ratio and subclinical coronary atherosclerosis (34).…”

Diagnosis of coronary artery disease in patients with type 2 diabetes mellitus based on computed tomography and pericoronary adipose tissue radiomics: a retrospective cross-sectional study

“…Risk factors for CAD are classified according to the following criteria: (A) Hypertension: systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg and/or use of antihypertensive medication according to the guidelines [29]; (B) Dyslipidaemia: dyslipidaemia defined as fasting total cholesterol > 6.2 mmol/L, low-density lipoprotein (LDL) cholesterol > 3.4 mmol/L, high-density lipoprotein (HDL) cholesterol < 1.0 mmol/L, serum triglycerides > 1.7 mmol/L (outpatient only), or diagnosis/ treatment of dyslipidaemia [30]; (C) Diabetes mellitus: patients on oral hypoglycaemic agents or insulin or with fasting blood glucose ≥ 7.0 mmol/L are defined as T2DM [31]; (D) Family history of CAD: family history of ≥ 1 degree of consanguinity with CAD before age 60 [20]; (E) Obesity: BMI ≥ 28 kg/m 2 is considered to be obese [32]. Diabetes-related complications include (A) retinopathy: any medical basis for retinopathy; (B) neuropathy: any sign or symptom of polyneuropathy; (C) peripheral arterial occlusive disease: 50% stenosis on ultrasonography; and (D) nephropathy: renal failure, i.e., glomerular filtration rate < 60 mL/min and/or micro or macro proteinuria [33,34].…”

Slimming cardiac adipose tissue with liraglutide: pericardial is not epicardial fat (the LIRAFLAME substudy)

“…This is surprising, as we recently reported an independent association between EAT volume measured with CT and CAC score in 409 patients with diabetes. 9 This may be atributable to insufficient statistical power, as this subanalysis was not prespecified in the original study 2 and no sample size calculation could be performed beforehand.…”