Efficacy of cardiometabolic drugs in reduction of epicardial adipose tissue: a systematic review and meta-analysis

Abstract

Background Epicardial adipose tissue (EAT) plays an important role in cardiometabolic risk. EAT is a modifiable risk factor and could be a potential therapeutic target for drugs that already show cardiovascular benefits. The aim of this study is to evaluate the effect of cardiometabolic drugs on EAT reduction. Methods A detailed search related to the effect on EAT reduction due to cardiometabolic drugs, such as glucagon-like peptide-1 receptor agonist (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors (SGLT2-i), and statins was conducted according to PRISMA guidelines. Eighteen studies enrolling 1064 patients were included in the qualitative and quantitative analyses. Results All three analyzed drug classes, in particular GLP-1 RA, show a significant effect on EAT reduction (GLP-1 RA standardize mean difference (SMD) = − 1.005; p < 0.001; SGLT2-i SMD = − 0.552; p < 0.001, and statin SMD = − 0.195; p < 0.001). The sensitivity analysis showed that cardiometabolic drugs strongly benefit EAT thickness reduction, measured by ultrasound (overall SMD of − 0.663; 95%CI − 0.79, − 0.52; p < 0.001). Meta-regression analysis revealed younger age and higher BMI as significant effect modifiers of the association between cardiometabolic drugs and EAT reduction for both composite effect and effect on EAT thickness, (age Z: 3.99; p < 0.001 and Z: 1.97; p = 0.001, respectively; BMI Z: − 4.40; p < 0.001 and Z: − 2.85; p = 0.004, respectively). Conclusions Cardiometabolic drugs show a significant beneficial effect on EAT reduction. GLP-1 RA was more effective than SGLT2-i, while statins had a rather mild effect. We believe that the most effective treatment with these drugs should target younger patients with high BMI. Graphical Abstract

Vitamin D status and tic disorder: a systematic review and meta-analysis of observational studies

“…Subgroup analysis and sensitivity analysis were used to explore the heterogeneity. Publication bias was assessed by visually checking funnel plots and conducting Egger's regression and Begg's adjusted rank correlation asymmetry tests ( 22 – 24 ). P value < 0.05 was considered significant.…”

Epicardial adipose tissue, metabolic disorders, and cardiovascular diseases: recent advances classified by research methodologies

“…Numerous classes of drugs have been used to target EAT amount; antidiabetic and lipid-lowering drugs are the most studied among them. 129,[140][141][142][167][168][169][170][171][172][173][174][175] 6.3.1 Sodium-glucose cotransporter-2 inhibitors Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are a new type of antidiabetic drug that significantly reduce cardiovascular incidence and mortality in patients with T2DM. [176][177][178] Furthermore, existing evidence has shown that SGLT-2 inhibitors can significantly reduce body weight and VAT.…”

“…In the past decade, four types of interventions have been proposed to reduce EAT volume, including exercise interventions, dietary interventions, bariatric surgery, and pharmaceutical interventions 129–134 (Figure 3). There have been a number of well‐designed tables summarizing related clinical studies in recent systematic reviews 134–142 …”

Epicardial Fat Paradox and Differential Effects of GLP-1 Receptor Agonists Across Heart Failure Phenotypes

“…13 Indeed, GLP-1RA treatment, compared with SGLT2 inhibitors, led to a 2× stronger reduction in EAT thickness within 12 weeks. 14 Together, these may form the basis of GLP-1RAs' benefits in inflammatory HFpEF and pre-HF phenotypes. 4,5…”