1 Steno Diabetes Center, Denmark.
2 Center of Inflammation and Metabolism/Center for Physical Activity Research (CIM/CFAS), University of Copenhagen, Denmark.
Eur J Prev Cardiol. 2017 Sep;24(14):1517-1524. doi: 10.1177/2047487317717820. Epub 2017 Jun 26.
Background We evaluated the association of cardiac adipose tissue including epicardial adipose tissue and pericardial adipose tissue with incident cardiovascular disease and mortality, coronary artery calcium, carotid intima media thickness and inflammatory markers. Design A prospective study of 200 patients with type 2 diabetes and elevated urinary albumin excretion rate (UAER). Methods Cardiac adipose tissue was measured from baseline echocardiography. The composite endpoint comprised incident cardiovascular disease and all-cause mortality. Coronary artery calcium, carotid intima media thickness and inflammatory markers were measured at baseline. Cardiac adipose tissue was investigated as continuous and binary variable. Analyses were performed unadjusted (model 1), and adjusted for age, sex (model 2), body mass index, low-density lipoprotein cholesterol, smoking, glycated haemoglobin, and systolic blood pressure (model 3). Results Patients were followed-up after 6.1 years for non-fatal cardiovascular disease ( n = 29) or mortality ( n = 23). Cardiac adipose tissue ( p = 0.049) and epicardial adipose tissue ( p = 0.029) were associated with cardiovascular disease and mortality in model 1. When split by the median, patients with high cardiac adipose tissue had a higher risk of cardiovascular disease and mortality than patients with low cardiac adipose tissue in unadjusted (hazard ratio 1.9, confidence interval: 1.1; 3.4, p = 0.027) and adjusted (hazard ratio 2.0, confidence interval: 1.1; 3.7, p = 0.017) models. Cardiac adipose tissue ( p = 0.033) was associated with baseline coronary artery calcium (model 1) and interleukin-8 (models 1-3, all p < 0.039). Conclusions In type 2 diabetes patients without coronary artery disease, high cardiac adipose tissue levels were associated with increased risk of incident cardiovascular disease or all-cause mortality even after accounting for traditional cardiovascular disease risk factors. High cardiac adipose tissue amounts were associated with subclinical atherosclerosis (coronary artery calcium) and with the pro-atherogenic inflammatory marker interleukin-8.
背景 我们评估了心脏脂肪组织（包括心外膜脂肪组织和心包脂肪组织）与心血管疾病和死亡率、冠状动脉钙、颈动脉内膜中层厚度和炎症标志物的发生之间的关联。 设计 一项对 200 例 2 型糖尿病和尿白蛋白排泄率（UAER）升高患者的前瞻性研究。 方法 从基线超声心动图测量心脏脂肪组织。复合终点包括心血管疾病的发生和全因死亡率。在基线时测量冠状动脉钙、颈动脉内膜中层厚度和炎症标志物。心脏脂肪组织作为连续和二分类变量进行研究。分析未调整（模型 1），并根据年龄、性别（模型 2）、体重指数、低密度脂蛋白胆固醇、吸烟、糖化血红蛋白和收缩压进行调整（模型 3）。 结果 患者在 6.1 年后因非致命性心血管疾病（n=29）或死亡率（n=23）进行随访。在模型 1 中，心脏脂肪组织（p=0.049）和心外膜脂肪组织（p=0.029）与心血管疾病和死亡率相关。按中位数划分时，与心脏脂肪组织低的患者相比，心脏脂肪组织高的患者在未调整（风险比 1.9，置信区间：1.1；3.4，p=0.027）和调整（风险比 2.0，置信区间：1.1；3.7，p=0.017）模型中发生心血管疾病和死亡的风险更高。心脏脂肪组织（p=0.033）与基线时的冠状动脉钙（模型 1）和白细胞介素-8（模型 1-3，均 p<0.039）相关。 结论 在无冠状动脉疾病的 2 型糖尿病患者中，即使考虑到传统的心血管疾病危险因素，心脏脂肪组织水平高与心血管疾病或全因死亡率的发生风险增加相关。心脏脂肪组织含量高与亚临床动脉粥样硬化（冠状动脉钙）和致动脉粥样硬化的炎症标志物白细胞介素-8相关。
