Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes?

Abstract

Type 2 diabetes (T2D) is associated with an increased risk of cardiovascular disease and heart failure, which highlights the need for improved understanding of factors contributing to the pathophysiology of these complications as they are the leading cause of mortality in T2D. Patients with T2D have high levels of epicardial adipose tissue (EAT). EAT is known to secrete inflammatory factors, lipid metabolites, and has been proposed to apply mechanical stress on the cardiac muscle that may accelerate atherosclerosis, cardiac remodeling, and heart failure. High levels of EAT in patients with T2D have been associated with atherosclerosis, diastolic dysfunction, and incident cardiovascular events, and this fat depot has been suggested as an important link coupling diabetes, obesity, and cardiovascular disease. Despite this, the predictive potential of EAT in general, and in patients with diabetes, is yet to be established, and, up until now, the clinical relevance of EAT is therefore limited. Should this link be established, importantly, studies show that this fat depot can be modified both by pharmacological and lifestyle interventions. In this review, we first introduce the role of adipose tissue in T2D and present mechanisms involved in the pathophysiology of EAT and pericardial adipose tissue (PAT) in general, and in patients with T2D. Next, we summarize the evidence that these fat depots are elevated in patients with T2D, and discuss whether they might drive the high cardiometabolic risk in patients with T2D. Finally, we discuss the clinical potential of cardiac adipose tissues, address means to target this depot, and briefly touch upon underlying mechanisms and future research questions.

Epicardial adipose tissue volume and coronary calcification among people living with diabetes: a cross-sectional study

“…Second, increased EAT volume/thickness has been associated with markers of subclinical atherosclerosis other than CAC score, such as coronary artery disease and cardiac dysfunction [5]. Third, whereas EAT is physiologically cardioprotective -as it provides mechanical protection and energy to the myocardium and has anti-in ammatory properties -abnormally increases in EAT volume is proin ammatory [3][4][5][6]. Similarly, EAT volume has been associated with plaque vulnerability, which may contribute to acute coronary syndrome [26].…”

“…Indeed, retinopathy and nephropathy are also known markers of poor cardiovascular prognosis in people with diabetes [8,10]. Second, increased EAT volume/thickness has been associated with markers of subclinical atherosclerosis other than CAC score, such as coronary artery disease and cardiac dysfunction [5]. Third, whereas EAT is physiologically cardioprotective -as it provides mechanical protection and energy to the myocardium and has anti-in ammatory properties -abnormally increases in EAT volume is proin ammatory [3][4][5][6].…”

“…There is no fascia separating EAT and myocardium. Therefore both tissues are in direct contact [3][4][5][6]29]. To date, EAT is the only type of cardiac adipose tissue which has been observed to predict incident cardiovascular events in T2D patients [28].…”

“…EAT is located between the myocardium and the visceral pericardium and is considered the heart's visceral adipose tissue [3][4][5][6]. It secretes in ammatory factors and lipid metabolites, and has been suggested as a possible determinant of accelerated atherosclerosis [3][4][5][6]. However, at the clinical level, evidence that EAT is a marker of subclinical atherosclerosis in diabetic populations is still limited [5].…”

Adipose Tissue Development and Expansion from the Womb to Adolescence: An Overview

“…Moreover, a greater infiltration of macrophages (CD8+ and CD4+ T cells) in epicardial and pericardial AT were found in samples from patients with coronary artery disease and congenital heart disease [ 9 ]. Given the pro-inflammatory profile of epicardial and pericardial AT, several studies have investigated their roles on chronic diseases, such as diabetes [ 151 ] and cardiovascular diseases [ 152 ].…”