Endocrine Abstracts

Patients with impaired glucose metabolism, either prediabetes (preD) or type 2 Diabetes (T2D), and non-alcoholic fatty liver disease (NAFLD) have a higher prevalence of cardiovascular events. Recent studies have shown a relationship between epicardial fat and myocardial ischemia.

Objective: To determine whether hepatic fibrosis assessed by liver elastography (LE) or Fibrosis-4 (FIB-4) score correlates with epicardial fat volume quantified by computed tomography (CT), as a risk marker of cardiovascular disease.

Methods: Cross-sectional study in patients with preD or T2D and NAFLD. Clinical data, serum markers and imaging studies (CT and LE) were obtained between May 2016 and December 2017. Patients with other causes of liver disease were excluded. Epicardial fat was quantified semiautomatically including voxels with attenuation values between −45 to −190 Hounsfield units. In LE, an increased liver stiffness was considered if ≥8.2 kPa. A FIB-4 Score (age in years×AST)(platelet count×√ALT) ≥2.67 was considered as possible fibrosis.

Results: Twenty-five patients met inclusion criteria. 84% (21/25) were men with an average age of 61.52±13yo, BMI of 31.44±3.15 kg/m² and body fat (CUN-BAE) of 36.04±4.75%. 72% (18/25) had hypertension, 76% (19/25) dyslipidemia, 36% (9/25) SAOS, 20% (5/25) hyperuricemia and 60% (15/25) were ex-smokers or current smokers. Moderate-severe insulin resistance was observed (HOMA-IR of 9.47±5,263). 52% (13/25) had T2D with an average glycosylated hemoglobin of 6.68±1.67%. A 24% (6/25) presented increased liver stiffness assessed by LE. A significant positive correlation was found between epicardial fat and liver stiffness measured by LE (r=0.45, P=<0.05), as well as between epicardial fat and FIB-4 Score (r=0.410, P=0.05). Patients with increased liver stiffness had higher epicardial fat compared to patients with liver stiffness <8.2 kPa (289.83±119.93 cm³ versus 171.89±98.72 cm³, P=0.023). Additionally, a positive correlation was found between epicardial fat and AST levels (r=0.411, P=<0.05), triglycerides (r=0.49, P=<0.05), the presence of dyslipidemia, obesity and the occasional alcohol consumption (r=0.429, P=<0.05, r=0.468, P=<0.05 and r=0.708, P=<0.01, respectively). A significant negative correlation was found between epicardial fat and HDL levels (r=−0.434, P=<0.05).

Conclusions: In patients with impaired glucose metabolism, liver fibrosis assessed by LE or FIB-4 Score correlates positively with epicardial fat volume. The early identification of these situations allow us to establish preventive measures to reduce cardiovascular risk.