Abstract
Visceral fat is an independent predictor of the cardiovascular risk in subjects with type 2 diabetes (T2DM), but it is rarely assessed during an outpatient visit. Epicardial fat (EAT), the visceral fat of the heart, plays a role in coronary artery disease (CAD). EAT thickness can be clinically assessed with standard ultrasound. In this study we sought to evaluate the association of ambulatory ultrasound measured EAT thickness with CAD in asymptomatic well controlled T2DM subjects on metformin monotherapy during outpatient visits.
This was single center, pragmatic study in 142 T2DM patients. Each subject underwent baseline ultrasound EAT thickness measurement, anthropometric and biomarkers. The incidence of CAD was detected after 1 year. At baseline, HbA1c was 6.7 % and BMI 34.9 kg/m2, EAT thickness was 8.3 ± 2.3 in women and 9.4 ± 2.4 mm in men, higher than threshold values for high cardiovascular risk. In multivariate models, EAT was the only statistically significant correlate of CAD at 1-year f/u (p = 0.04). Conclusions Point of care ultrasound measured EAT thickness is a good correlate of CAD in well controlled and asymptomatic T2DM subjects on metformin monotherapy. EAT thickness predicted CAD better than traditional risk factors, such as BMI, HbA1c, age, blood pressure or duration of diabetes.
•Visceral fat plays a major role in diabetes-related cardiovascular risk. However visceral fat is not routinely assessed during outpatient visit.•Patients risk is often based on traditional parameters such as A1c, BMI.•Epicardial fat is strongly associated with diabetes related cardiovascular diseases.•Epicardial fat thickness can be easily and not invasively measured with ultrasound in an outpatient visit. Epicardial fat is marker of visceral fat.•In this real world study we found that ultrasound measured epicardial fat thickness was the best predictor of CAD in patients with well controlled type 2 diabetes and obesity on Metformin monotherapy.•Ultrasound assessment of visceral fat during outpatient visit can provide a better stratification of the cardiovascular risk than traditional markers in type 2 patients who would have been considered at low risk based only on A1c.