Abstract
BackgroundCardiac adipose tissue may have local paracrine effects on epicardial arteries and the underlying myocardium, promoting calcification and affecting myocardial microcirculation. We explored whether the total amount of cardiac adipose tissue was associated with coronary artery calcium score (CAC) and myocardial flow reserve in persons with type 1 or type 2 diabetes and healthy controls.MethodsWe studied three groups: (1) 30 controls, (2) 60 persons with type 1 diabetes and (3) 60 persons with type 2 diabetes. The three groups were matched for sex and age. The three groups derived from retrospective analysis of two clinical studies. All underwent cardiac 82Rb positron emission tomography/computed tomography (PET/CT) scanning. Cardiac adipose tissue volume (the sum of epicardial and pericardial fat), CAC, and myocardial flow reserve (ratio of pharmacological stress flow and rest flow) were evaluated using semiautomatic software. We applied linear regression to assess the association between cardiac adipose tissue, CAC and myocardial flow reserve.ResultsMean (SD) cardiac adipose tissue volume was 99 (61) mL in the control group, 106 (78) mL in the type 1 diabetes group and 228 (97) mL in the type 2 diabetes group. Cardiac adipose tissue was positively associated with body mass index in all three groups (p ≤ 0.02). In the controls, cardiac adipose tissue was positively associated with CAC score (p = 0.008) and negatively associated with myocardial flow reserve (p = 0.005). However, cardiac adipose tissue was not associated with CAC or myocardial flow reserve in the groups including persons with type 1 or type 2 diabetes (p ≥ 0.50).ConclusionsIn contrast to what was found in healthy controls, we could not establish a relation between cardiac adipose tissue and coronary calcification or myocardial microvascular function in person with type 1 or type 2 diabetes. The role of cardiac adipose tissue in cardiovascular disease in diabetes remains unclear.
Highlights
Cardiac adipose tissue may have local paracrine effects on epicardial arteries and the underlying myocardium, promoting calcification and affecting myocardial microcirculation
Reversible ischemia was observed on the cardiac positron emission tomography (PET)/ computed tomography (CT) in 1 control person, participants with type 1 diabetes (7 of whom were known with coronary artery disease) and participants with type 2 diabetes
The cardiac adipose tissue level was comparable in controls and persons with type 1 diabetes, significantly higher in persons with type 2 diabetes compared to controls (p < 0.0001) and type 1 diabetes (p < 0.0001)
Summary
Cardiac adipose tissue may have local paracrine effects on epicardial arteries and the underlying myocardium, promoting calcification and affecting myocardial microcirculation. We explored whether the total amount of cardiac adipose tissue was associated with coronary artery calcium score (CAC) and myocardial flow reserve in persons with type 1 or type 2 diabetes and healthy controls. Cardiac adipose tissue is a highly metabolic active fat depot surrounding the heart and coronary arteries. It includes epi- and pericardial adipose tissue. High levels of epicardial adipose tissue have been associated with incident cardiovascular disease and mortality in persons ( men) with type 2 diabetes in our previous study [2] and was associated with increased risk of coronary artery disease in persons with a high risk of cardiovascular disease, of whom 45% had type 2 diabetes [3]. A study in persons with type 1 diabetes could not demonstrate an association between the epicardial adipose tissue volume and coronary atherosclerosis [6]
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