Epicardial Adipose Tissue Is Related to Arterial Stiffness and Inflammation in Patients with Cardiovascular Disease and Type 2 Diabetes

Background: Epicardial adipose tissue (EAT) is an emerging cardio-metabolic risk factor and has been shown to correlate with adverse cardiovascular (CV) outcome; however the underlying pathophysiology of this link is not well understood. The aim of this study was to evaluate the relationship between EAT and a comprehensive panel of cardiovascular risk biomarkers and pulse wave velocity (PWV) and indexed left ventricular mass (LVMI) in a cohort of patients with cardiovascular disease (CVD) and diabetes compared to controls.

Methods: 145 participants (mean age 63.9 ± 8.1 years; 61% male) were evaluated. All patients underwent cardiovascular magnetic resonance (CMR) examination and PWV. EAT measurements from CMR were performed on the 4-chamber view. Blood samples were taken and a range of CV biomarkers was evaluated.

Results: EAT measurements were significantly higher in the groups with CVD, with or without T2DM compared to patients without CVD or T2DM (group 1 EAT 15.9 ± 5.5 cm² vs. group 4 EAT 11.8 ± 4.1 cm2, p=0.001; group 3 EAT 15.1 ± 4.3cm² vs. group 4 EAT 11.8 ± 4.1 cm2, p=0.024). EAT was independently associated with IL-6 (beta 0.2, p=0.019). When added to clinical variables, both EAT (beta 0.16, p=0.035) and IL-6 (beta 0.26, p=0.003) were independently associated with PWV. EAT was significantly associated with LVMI in a univariable analysis but not when added to significant clinical variables.

Conclusions: In patients with cardio-metabolic disease, EAT was independently associated with PWV. EAT may be associated with CVD risk due to an increase in systemic vascular inflammation. Whether targeting EAT may reduce inflammation and/or cardiovascular risk should be evaluated in prospective studies.