Abstract
Imbalance between pro- and anti-inflammatory cytokines secreted from visceral adipose tissue (VAT) contributes to the pathogenesis of certain cardiovascular and metabolic disorders, including insulin resistance. Epicardial adipose tissue (EAT) is a form of VAT mainly concentrated along the coronary arteries. It has been shown in various studies that EAT thickness is positively correlated with cardiovascular disease. Due to its high worldwide prevalence, prevention and management of type 2 diabetes (T2D) has become a major public health challenge. Metformin, the most widely prescribed drug to treat T2D, has favorable effects on VAT and body weight. As metformin decreases VAT mass, in this prospective study we analyzed the possible positive effect of metformin on EAT mass, which is organ-specific VAT, and body mass index (BMI). Subjects were selected from patients admitted to the internal medicine outpatient clinic. Newly diagnosed T2D patients treated with metformin monotherapy were analyzed and 40 patients were included. EAT thickness in the included patients was measured echocardiographically. BMI and EAT thickness were analyzed at the beginning (BMI0 and EAT0) and after three months of metformin monotherapy (BMI3 and EAT3). There was a statistically significant decrease in EAT thickness after three months of metformin monotherapy (EAT0=5.07±1.33 mm vs. EAT3=4.76±1.32 mm; p<0.001). Furthermore, BMI was also significantly decreased (BMI0=28.27±2.71 vs. BMI3=27.29±2.10; p<0.0001). In this study we show that metformin monotherapy significantly decreases EAT thickness and BMI in T2D patients. This suggests that metformin could reduce the frequency of coronary atherosclerosis. O desequilíbrio entre as citocinas pro e anti-inflamatórias segregadas pelo tecido adiposo visceral (TAV) contribui para a patogénese de certas doenças cardiovasculares e metabólicas, incluindo a resistência à insulina. O tecido adiposo epicárdico (EAT) é o TAV, concentrado principalmente ao longo das artérias coronárias. É previamente demonstrado em vários estudos que a espessura do EAT está positivamente correlacionada com a frequência de doença cardiovascular. Devido à alta prevalência mundial, a prevenção e tratamento da diabetes mellitus tipo 2 (DM2) tornou-se um grande desafio para a saúde pública. A metformina, o medicamento mais amplamente prescrito para o tratamento da DM2, tem efeitos favoráveis no TAV e no peso corporal. Como a metformina diminui a massa do TAV, neste estudo prospetivo, analisamos o possível efeito positivo da metformina na massa do EAT, que é o TAV do órgão e o índice de massa corporal. Os indivíduos foram selecionados dos doentes admitidos no ambulatório de medicina interna. Doentes recém-diagnosticados com DM2 tratados com metformina em monoterapia foram investigados. Foram incluídos 40 doentes. A espessura do EAT dos doentes incluídos foi medida por ecocardiografia. A espessura do IMC e do EAT no início e três meses após a monoterapia com metformina foi analisada. Houve redução estatisticamente significativa na espessura do EAT após três meses de monoterapêutica com metformina (EAT0=5,07±1,33 mm versus EAT3=4,76±1,32 mm; p<0,001). Além disso, o IMC também diminuiu significativamente (IMC0=28,27±2,71 versus IMC3=27,29±2,10; p<0,0001). Conclusões Neste estudo, verificámos que a metformina em monoterapia diminui significativamente a espessura do EAT e o IMC nos doentes com DM2, pelo que se pode concluir que a metformina pode reduzir a frequência de aterosclerose coronária.
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More From: Revista Portuguesa de Cardiologia (English Edition)
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