Computed Tomography-Estimated Pancreatic Steatosis is Associated with Carotid Plaque in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study from China

Abstract

To explore potential effects of pancreatic fat content measured by computed tomography (CT) on carotid plaque in patients with type 2 diabetes mellitus (T2DM). Methods: T2DM patients who underwent an un-enhanced CT scan of the upper abdomen and ultrasound of the carotid artery were enrolled. The patients were divided into a non-plaque group and a plaque group (including hypoechoic plaque subgroup and non-hypoechoic plaque subgroup). The CT attenuation of pancreas and spleen were measured. Pancreas-to-spleen attenuation ratio (P/S) and the difference between pancreatic and splenic attenuation (P-S) were calculated. The cutoff values of P/S and P-S were obtained using receiver operating characteristic curves. Logistic regression models were used to evaluate association of P/S or P-S with carotid plaque or hypoechoic plaque. Results: 337 patients were enrolled, including 101 cases in the non-plaque group, 146 cases in the hypoechoic plaque subgroup, and 90 cases in the non-hypoechoic plaque subgroup. P/ S and P-S in hypoechoic plaque group were lower than those in non-plaque group, with a cut off value of P/S and P-S as 0.72 and −13.33, respectively.

Intra‐pancreatic fat is associated with continuous glucose monitoring metrics

“…35,36 Recent clinical studies confirm this observation, where fatty change of the pancreas was associated with the thickening of epicardial adipose tissue and aortic intimamedia (markers of subclinical atherosclerosis). 37 There have also been reports of a significantly increased carotid intima-media thickness, 9,38 a higher prevalence of carotid artery plaque and vascular stiffness, 10,39 as well as coronary and carotid calcification in the presence of fatty change of the pancreas. 40 Similarly, CGM metrics have been shown to be associated with cardiovascular pathologies.…”

MRI-Measured Pancreatic Fat Correlates with Increased Arterial Stiffness in Patients Who are Overweight and Obese

“… 10 Thus, it is clear that conventional risk factors have some effect on the relationship between fatty pancreas and atherosclerosis. In addition, the study populations in previous studies mainly involved patients with NAFLD 6 , 7 and T2DM, 5 , 9 whereas the participants selected for this study were patients with overweight and obesity.…”

“… 8 Moreover, a Chinese study suggested that CT-estimated pancreatic fat content correlated with carotid plaque in patients with T2DM. 9 Yet another study found a direct link between carotid artery calcification and pancreatic fat. 10 However, the direct connection between NAFPD and atherosclerosis became weaker after adjusting for confounding factors.…”

Remnant cholesterol, but not low‐density lipoprotein cholesterol, is associated with intra‐pancreatic fat deposition

“…First, since this was a cross‐sectional study, we cannot make assumptions of causality. Although we believe abnormal components of the lipid panel (in particular, high remnant cholesterol) may have implications in the development of IPFD and that increased IPFD may have a role in the development of cardiovascular diseases, 9,10 longitudinal studies would be required to confirm the presence of any causal relationships. Second, while several genetic disorders (e.g., familial chylomicronaemia syndrome) are associated with abnormalities of the lipid panel, our study did not analyse genetic factors 31 .…”

“…A comprehensive meta‐analysis of clinical outcomes from 24 studies revealed that people with fatty pancreas had a 67% significantly increased risk for arterial hypertension 8 . Also, an earlier clinical study found that fatty pancreas was significantly associated with a 3.1‐times higher chance of carotid atherosclerosis in non‐obese people, 9 whereas a recent clinical study showed that fatty pancreas was significantly associated with a 2.8‐times higher chance of carotid plaques in people with type 2 diabetes 10 . Further, an autopsy study reported that fatty pancreas was significantly associated with severe atherosclerosis 11 …”