Introduction & Objectives: While extremely high levels of lipoprotein (a) [Lp(a)] are associated with an increased risk of cardiovascular disease, very low levels of Lp(a) have been associated with an increased risk of diabetes. The underlying mechanisms explaining this association are still unknown. Epicardial adipose tissue (EAT) is increased in diabetes and predicts the development of coronary artery disease and heart failure. This study aimed at evaluating the correlation between Lp(a) and EAT in subjects living with diabetes.
Methods: We collected clinical data from 1,093 subjects living with diabetes in a monocentric retrospective observational study. Patients were included if they were in primary prevention, had had a measurement of Lp(a) and computed tomography (CT) for coronary artery calcium score quantification. Volumetric quantification of EAT was performed on CT images.
Results: We included 649 people living with diabetes (76.3% T2DM, 16.5% T1DM, 7.2% others) for 13.5±9.6 years, body mass index (BMI) 29.3±6.0 kg/m², HbA1c 8.9±2.3%, EAT volume 91±41 cm3. EAT volume and Lp(a) levels were correlated (r=-0.2, p<0.0001). High Lp(a) levels, defined as >30 mg/dl (n=227, 35%), were more frequent in women and people from sub-Saharan Africa, and associated with higher HDL (p<0.001) and LDL cholesterol (p<0.01), lower triglycerides (p<0.001) and lower EAT volume (91±36 vs. 97±42 cm3, p<0.001)). EAT volume decreased with increasing quartiles of Lp(a) (p<0.001). After adjustment for age, sex, ethnic origin, type of diabetes, triglycerides, LDL and HDL cholesterol, EAT volume remained negatively associated with higher Lp(a) levels (per 10 cm3: odds ratio 0.93 [95% confidence interval 0.88-0.99], p<0.05).
Conclusions: Low Lp(a) is associated with higher EAT volume in asymptomatic subjects living with diabetes. These exploratory results provide pivotal insights into the unexplored dynamics between Lp(a) levels and diabetes that deserve further exploration.
E. Cosson: Advisory Panel; Abbott, AstraZeneca, Lilly Diabetes, Novo Nordisk, Sanofi, Roche Diagnostics, Novartis AG, Amgen Inc. S. Tatulashvili: None. H. Bihan: None. M. Boubaya: None. A. Gallo: Consultant; Akcea Thearpeutics, Inc. Speaker's Bureau; Amarin Corporation. Consultant; Amgen Inc. Advisory Panel; Amryt Pharma Plc. Research Support; Eli Lilly and Company, Ionis Pharmaceuticals. Consultant; Novartis Pharmaceuticals Corporation, Sanofi. Speaker's Bureau; Servier Laboratories. Board Member; Ultragenyx.
