Epicardial adipose tissue predicts incident cardiovascular disease and mortality in patients with type 2 diabetes
Epicardial adipose tissue predicts incident cardiovascular disease and mortality in patients with type 2 diabetes
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DOI：
10.1186/s12933-019-0917-y
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发表时间：
2019-08-30
影响因子：
9.3
通讯作者：
Jorgensen, Peter G.
中科院分区：
文献类型：
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作者：
Christensen, Regitse H.;von Scholten, Bernt Johan;Jorgensen, Peter G.
背景心脏脂肪是一种心血管生物标志物，但其在2型糖尿病患者中的重要性尚不清楚。目的是评估心外膜（EAT）、心包（PAT）和心脏总脂肪（CAT）在2型糖尿病中的预测潜力，并阐明性别差异。方法应用超声心动图检测1030例2型糖尿病患者的EAT和PAT。通过国家登记系统进行随访。终点是心血管疾病（CVD）和全因死亡率的复合终点。分析未调整（模型1），调整年龄和性别（模型2），加上收缩压，体重指数（BMI），低密度脂蛋白（LDL），吸烟，糖尿病病程和糖化血红蛋白（HbA（1c））（模型3）。结果中位随访时间为4.7年，248例患者（191例男性和57例女性）达到复合终点。高EAT患者（>中位数水平）增加了模型1中复合终点的风险[风险比（HR）：1.46（1.13; 1.88），p = 0.004]，模型2 [HR：1.31（1.01; 1.69），p = 0.038]和模型3中的临界值[HR：1.32（0.99; 1.77），p = 0.058]。对于男性，而不是女性，高EAT与模型3中CVD和死亡率风险增加41%相关（p = 0.041）。当将高EAT添加到模型3中时，净重新分类指数改善（19.6%，p = 0.035）。PAT或CAT与终点无关。结论在调整CVD危险因素后，高水平EAT与2型糖尿病患者（尤其是男性）的CVD事件和死亡率复合相关。EAT适度改善了CVD风险因素的风险预测。
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 (HbA(1c)) (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.