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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 (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.

SUBMITTER: Christensen RH

PROVIDER: S-EPMC6716926 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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

Christensen Regitse H RH von Scholten Bernt Johan BJ Hansen Christian S CS Jensen Magnus T MT Vilsbøll Tina T Rossing Peter P Jørgensen Peter G PG

Cardiovascular diabetology 20190830 1

<h4>Background</h4>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.<h4>Methods</h4>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 cardiovasc ...[more]

PMID: 31470858

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Project description:BackgroundSkin autofluorescence (SAF) is a non-invasive marker of tissue accumulation of advanced glycation endproducts (AGE). Recently, we demonstrated in the general population that elevated SAF levels predict the development of type 2 diabetes (T2D), cardiovascular disease (CVD) and mortality. We evaluated whether elevated SAF may predict the development of CVD and mortality in individuals with T2D.MethodsWe included 2349 people with T2D, available baseline SAF measurements (measured with the AGE reader) and follow-up data from the Lifelines Cohort Study. Of them, 2071 had no clinical CVD at baseline. 60% were already diagnosed with diabetes (median duration 5, IQR 2-9?years), while 40% were detected during the baseline examination by elevated fasting blood glucose ?7.0?mmol/l) and/or HbA1c ?6.5% (48?mmol/mol).ResultsMean (±SD) age was 57?±?12?yrs., BMI 30.2?±?5.4?kg/m2. 11% of participants with known T2D were treated with diet, the others used oral glucose-lowering medication, with or without insulin; 6% was using insulin alone. Participants with known T2D had higher SAF than those with newly-detected T2D (SAF Z-score 0.56?±?0.99 vs 0.34?±?0.89?AU, p?<?0.001), which reflects a longer duration of hyperglycaemia in the former group. Participants with existing CVD and T2D had the highest SAF Z-score: 0.78?±?1.25?AU. During a median follow-up of 3.7?yrs., 195 (7.6%) developed an atherosclerotic CVD event, while 137 (5.4%) died. SAF was strongly associated with the combined outcome of a new CVD event or mortality (OR 2.59, 95% CI 2.10-3.20, p?<?0.001), as well as incidence of CVD (OR 2.05, 95% CI 1.61-2.61, p?<?0.001) and death (OR 2.98, 2.25-3.94, p?<?0.001) as a single outcome. In multivariable analysis for the combined endpoint, SAF retained its significance when sex, systolic blood pressure, HbA1c, total cholesterol, eGFR, as well as antihypertensive and statin medication were included. In a similar multivariable model, SAF was independently associated with mortality as a single outcome, but not with incident CVD.ConclusionsMeasuring SAF can assist in prediction of incident cardiovascular disease and mortality in individuals with T2D. SAF showed a stronger association with future CVD events and mortality than cholesterol or blood pressure levels.

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Dataset Information

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

Publications

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

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