Abstract
Epicardial adipose tissue (EAT) has been shown to have important effects on the development of coronary artery disease (CAD) through local paracrine influences on the vascular bed. We compared a cohort of asymptomatic patients with type II diabetes mellitus (DM) without known CAD to an age- and gender-matched group of asymptomatic patients without DM from the CTRAD (Cardiac CT's Role in Asymptomatic Patients with DM-II) study in which patients underwent a cardiac computed tomography angiogram, for early detection of CAD. Mean EAT volumes of 118.6 ± 43.0 and 70.0 ± 44.0cm(3) were found in the DM and non-DM groups, respectively. When stratified by the presence and severity of CAD, it was found that in the DM (p= 0.003) and non-DM groups (p <0.001), there was a statistically significant increase in EAT volume as the patients were found to have increasingly severe CAD. After adjusting for age, race, gender, DM, hypertension, insulin use, body mass index, and coronary artery calcium (CAC) score, the presence of >120cm(3) of EAT was found to be highly correlated with the presence of significant CAD (adjusted odds ratio 4.47, 95% confidence interval 1.35 to 14.82). We found that not only is EAT volume an independent predictor of CAD but that an increasing volume of EAT predicted increasing severity of CAD even after adjustment for CAC score.
Highlights
IntroductionEpicardial adipose tissue (EAT) volume has been demonstrated to potentially be a valuable independent predictor of the presence of coronary artery disease (CAD).[1,2,3,4] whether the relationship between EAT volume and CAD persists in asymptomatic patients with and without diabetes mellitus (DM), and if it persists after adjustment for coronary artery calcification (CAC) is unknown
Whether the relationship between Epicardial adipose tissue (EAT) volume and coronary artery disease (CAD) persists in asymptomatic patients with and without diabetes mellitus (DM), and if it persists after adjustment for coronary artery calcification (CAC) is unknown
Consequent insulin resistance and the increased prevalence of type II DM, death from CAD will remain high for the foreseeable future
Summary
Epicardial adipose tissue (EAT) volume has been demonstrated to potentially be a valuable independent predictor of the presence of coronary artery disease (CAD).[1,2,3,4] whether the relationship between EAT volume and CAD persists in asymptomatic patients with and without diabetes mellitus (DM), and if it persists after adjustment for coronary artery calcification (CAC) is unknown Prior studies investigating this issue have had selection bias, using patients that had indications for cardiovascular imaging, such as anginal symptoms or have used Asian populations, which may have different thresholds for visceral adiposity than other ethnic groups.[5,6] This study was designed to assess the correlation between elevated EAT volume and CAD presence and severity in an ethnically diverse asymptomatic patient population. We assessed this relation using a case control study design, comparing a cohort of asymptomatic patients with and without DM and examined the association of EAT volume with CAD severity adjusted for traditional CAD risk factors, body mass index (BMI) as well as CAC score
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