Abstract
BackgroundThe pathophysiology of cardiovascular complications in people with type 1 diabetes (T1DM) remains unclear. An increase in epicardial adipose tissue (EAT) and alterations in the composition of high-density lipoprotein (HDL) are associated with coronary artery disease, but information on its relationship in T1DM is very limited. Our aim was to determine the association between EAT volume, subclinical atherosclerosis, and HDL composition in type 1 diabetes.MethodsSeventy-two long-term patients with T1DM without clinical atherosclerosis were analyzed. EAT volume and subclinical atherosclerosis were measured using cardiac computed tomography angiography. EAT was adjusted according to body surface to obtain an EAT index (iEAT). HDL composition was determined.ResultsThe mean iEAT was 40.47 ± 22.18 cc/m2. The bivariate analysis showed positive associations of the iEAT with gender, age, hypertension, dyslipidemia, smoking, body mass index, waist circumference, insulin dose, and triglyceride (P < 0.05). The iEAT correlated positively with small HDL, increased content of apolipoprotein (apo)A-II and apoC-III, and decreased content of apoE and free cholesterol. Multiple linear regression showed that age, apoA-II content in HDL, and waist circumference were independently associated with the iEAT. Fifty percent of the patients presented subclinical atherosclerotic lesions. These patients had a higher iEAT, and their HDL contained less cholesterol and more apoA-II and lipoprotein-associated phospholipase A2 than patients without subclinical atherosclerosis.ConclusionAlterations in the composition of HDL in TIDM are associated with increased iEAT and the presence of subclinical atherosclerosis. We propose that these abnormalities of HDL composition could be useful to identify T1DM patients at highest cardiovascular risk.
Highlights
The pathophysiology of cardiovascular complications in people with type 1 diabetes (T1DM) remains unclear
high-density lipoprotein (HDL) from type 2 diabetes has an impaired anti-apoptotic and anti-inflammatory capacity and has partially lost its ability to promote cholesterol efflux from macrophages [7]. The loss of these anti-atherogenic properties of HDL in patients with diabetes is a consequence of proteome remodeling that includes, among other factors, alterations in the content of apolipoproteins and enzyme activities with anti-inflammatory properties associated with HDL [8]
In summary, our findings suggest that epicardial adipose tissue (EAT) may contribute to the pathogenesis of coronary atherosclerosis in patients with T1DM
Summary
The pathophysiology of cardiovascular complications in people with type 1 diabetes (T1DM) remains unclear. An increase in epicardial adipose tissue (EAT) and alterations in the composition of high-density lipoprotein (HDL) are associated with coronary artery disease, but information on its relationship in T1DM is very limited. Diabetic dyslipidemia is characterized by increased triglycerides (TG) and apoB and decreased high-density lipoprotein (HDL) concentrations [6] These quantitative abnormalities are pro-atherogenic per se, but they are accompanied by qualitative alterations of lipoproteins. HDL from type 2 diabetes has an impaired anti-apoptotic and anti-inflammatory capacity and has partially lost its ability to promote cholesterol efflux from macrophages [7] The loss of these anti-atherogenic properties of HDL in patients with diabetes is a consequence of proteome remodeling that includes, among other factors, alterations in the content of apolipoproteins (apoA-I, apoA-II, apoC-III, apoE) and enzyme activities with anti-inflammatory properties (lipoprotein associated phospholipase A2-Lp-PLA2-, paraoxonase-1-PON1-) associated with HDL [8]. The accumulation of epicardial fat is influenced by, among other factors, the abnormalities of the lipid profile, leading to high TG levels in blood, a typical feature of diabetic dyslipidemia
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