Plasminogen Activator Inhibitor-1 and Pericardial Fat in Individuals with Type 2 Diabetes Mellitus

Abstract

Background: Plasminogen activator inhibitor-1 (PAI-1) is implicated in the pathophysiology of cardiovascular disease (CVD) and increased in individuals with type 2 diabetes mellitus (T2DM). Adipose tissue produces PAI-1, and pericardial fat is a CVD risk factor. We sought to determine the relationship between PAI-1 and pericardial fat in males and females with well-controlled T2DM.

Methods: The study population consisted of 32 males and 19 females, aged 35-70 years with T2DM, without clinical evidence of CVD or other active medical problems except for hypertension. Subjects were studied under good cardiometabolic control. Study procedures included fasting blood work and cardiovascular imaging. Cardiac magnetic resonance imaging of the heart was used to identify and quantify pericardial fat from the bifurcation of the pulmonary trunk to the last slice containing cardiac tissue.

Results: PAI-1 was positively correlated with pericardial fat (β = 0.72, r = 0.72, P < 0.001) as well as with homeostatic model assessment of insulin resistance (r = 0.31, P = 0.03) and serum triglycerides (r = 0.27, P = 0.05). In a multivariable regression model, controlling for insulin sensitivity, triglycerides, and body mass index, pericardial fat was independently associated with PAI-1 (β = 0.80, P < 0.001).

Conclusions: PAI-1 is positively associated with pericardial fat in individuals with T2DM.

Keywords: adipose tissue; pericardial fat; plasminogen activator inhibitor-1; type 2 diabetes.

FIG. 1.

Example of axial T1 turbo spin echo slice. (A) Unmarked axial slice. (B) Axial slice after cardiac contours drawn. The pericardial fat is highlighted in red and is located between the green (outer paracardial fat and posterior periaortic fat borders) and red (myoepicardial border) lines as indicated by the green and red arrows. Fat is defined as tissue with pixel intensity more than four SDs above the mean pixel intensity for the reference posterior skeletal muscle (orange circle and orange arrow). SDs, standard deviations.

FIG. 2.

Pericardial fat is positively correlated with PAI-1; (n = 51; equation of regression line: y = 0.0013x + 0.1675). PAI-1, plasminogen activator inhibitor-1.