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Comparative Study
. 2019 Aug 30;18(1):114.
doi: 10.1186/s12933-019-0917-y.

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

Regitse H Christensen  1   2 , Bernt Johan von Scholten  3 , Christian S Hansen  3 , Magnus T Jensen  4   5 , Tina Vilsbøll  3   6 , Peter Rossing  3   6 , Peter G Jørgensen  5
Affiliations
Comparative Study

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

Regitse H Christensen et al. Cardiovasc Diabetol. .

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 (HbA1c) (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.

Keywords: Cardiovascular disease; Epicardial adipose tissue; Pericardial adipose tissue; Risk prediction.

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Conflict of interest statement

The authors declare that they have no competing interest associated with this manuscript. PR reports having given lectures for Astra Zeneca, Novo Nordisk, Eli Lilly, Bayer and Boehringer Ingelheim, and has served as a consultant for AbbVie, Astra Zeneca, BMS, Eli Lilly, Boehringer Ingelheim, Astellas, Janssen, and Novo Nordisk, all fees given to Steno Diabetes Center Copenhagen, and has equity interest in Novo Nordisk. TV has nothing to disclose. BJvS is now employed at Novo Nordisk and has equity interest in Novo Nordisk. PGJ reports having received lecture fees from Novo Nordisk.

Figures

Fig. 1
Fig. 1
Association of high vs. low EAT to risk of CVD and all-cause mortality. Kaplan–Meyer proportional hazards plot of epicardial adipose tissue (EAT) and risk of the composite end-point CVD or mortality in patients with EAT levels below the median (low EAT) group (blue) and above the median (high EAT) group (green). Hazard ratio (HR) 1.46 confidence interval (CI) 1.13; 1.88, p = 0.004 in the total population (a), HR 1.54 confidence interval (CI) 1.15; 2.10, p = 0.004 in men (b) and in women (c) HR: 1.22, CI 0.72; 2.06, p = 0.46
See this image and copyright information in PMC

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