Comparable epicardial adipose tissue burden in prediabetes with high cardiometabolic risk and early type 2 diabetes: A need for timely targeted therapies.

BACKGROUND

Epicardial adipose tissue (EAT) independently predicts adverse cardiovascular events. Prediabetes with metabolic syndrome carries high cardiovascular risk, yet EAT in this critical subpopulation versus incident type-2 diabetes (T2D) remains unexplored.

METHODS

Coronary CT-angiography records were retrospectively reviewed to compare adults with prediabetes (impaired fasting glucose 110–125 mg/dL and HbA1c < 6.5%) having ≥ 3 of 4 cardiometabolic risk indicators (overweight/obese, hypertension, statin use/hypertriglyceridemia, and statin use/low HDL-cholesterol; n = 44) with drug-naïve T2D (n = 44) and normoglycemic individuals (n = 50). Groups were matched for age, gender, body mass index (BMI), hypertension, statin use, smoking and coronary artery calcium score (CACS). EAT volume and attenuation were quantified using semi-automated software.

RESULTS

The high-risk prediabetes cohort (median age 53.5 [IQR 47–61] years; males 59.1%; overweight/obese, 95.5%; CACS > 0, 47.7%) exhibited EAT volume similar to T2D (median [IQR]: 93 [76.5-120.5] mL versus 88.4 [72.5–112] mL; pbonferroni=0.713), with both being significantly greater than normoglycemic individuals (72.8 [51–104] mL, pbonferroni<0.05). EAT/height2, EAT/body surface area(BSA) and EAT/BMI demonstrated similar trends; whereas average EAT attenuation did not differ across the groups. EAT/BSA demonstrated highest discriminatory ability for prediabetes (AUC = 0.683) and T2D (AUC = 0.692) from normoglycemia (p < 0.007). An EAT/BSA threshold of 48.0 mL/m2 for high-risk prediabetes yielded 66% specificity and 70.5% sensitivity.

CONCLUSION

Substantial EAT accumulation is evident in individuals with prediabetes and additional cardiometabolic risk indicators such as overweight, hypertension, and dyslipidemia. These findings highlight a critical need to explore timely targeted interventions to mitigate cardiovascular risk in this vulnerable subgroup akin to those employed in T2D.