Editorial comment
Epicardial adipose tissue: An important therapeutic target
Tecido adiposo epicárdico: um alvo terapêutico importante
Cristina M. Sena
Institute of Physiology, iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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"copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2019;38:419-23" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 199 "formatos" => array:3 [ "EPUB" => 27 "HTML" => 126 "PDF" => 46 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Metformin monotherapy significantly decreases epicardial adipose tissue thickness in newly diagnosed type 2 diabetes patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "419" "paginaFinal" => "423" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A monoterapia com metformina diminiu significativamente a espessura do tecido adiposo epicárdico nos doentes recentemente diagnosticados com diabetes tipo 2" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1555 "Ancho" => 1500 "Tamanyo" => 84135 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Effect of metformin monotherapy on BMI. BMI0: BMI before initiation of metformin monotherapy; BMI3: BMI after three months of metformin monotherapy; BMI: body mass index.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Murat Ziyrek, Serkan Kahraman, Emrah Ozdemir, Ali Dogan" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Murat" "apellidos" => "Ziyrek" ] 1 => array:2 [ "nombre" => "Serkan" "apellidos" => "Kahraman" ] 2 => array:2 [ "nombre" => "Emrah" "apellidos" => "Ozdemir" ] 3 => array:2 [ "nombre" => "Ali" "apellidos" => "Dogan" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919301746?idApp=UINPBA00004E" "url" => "/21742049/0000003800000006/v1_201909140841/S2174204919301746/v1_201909140841/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Epicardial adipose tissue: An important therapeutic target" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "425" "paginaFinal" => "426" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Cristina M. Sena" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Cristina M." "apellidos" => "Sena" "email" => array:1 [ 0 => "csena@ci.uc.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Institute of Physiology, iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tecido adiposo epicárdico: um alvo terapêutico importante" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease is the leading cause of death in Portugal, accounting for one third of all deaths.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The rising prevalence of cardiovascular risk factors such as obesity and type 2 diabetes is concerning, in Portugal as elsewhere in the world.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the modern era of obesity and diabetes pandemics, adipose tissue is in the spotlight. Epicardial adipose tissue (EAT) is the visceral fat depot of the heart<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and is of interest for cardiovascular diagnostics and therapeutics.</p><p id="par0015" class="elsevierStylePara elsevierViewall">EAT can be measured with standard echocardiography, as proposed and validated by Iacobellis et al.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> Echocardiographic EAT is a linear measurement at a single location and therefore may not reflect the variability of fat thickness or total EAT volume as measured by computed tomography.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Of note, EAT has been shown to correlate with waist circumference and intra-abdominal and intracardiac fat, and to serve as a good surrogate marker of visceral adiposity.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Impaired myocardial performance as assessed echocardiographically by left ventricular global longitudinal strain<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> was recently associated with increased myocardial fat content and enhanced EAT volume. EAT penetrates inside the human myocardium, affecting its biological behavior, which supports the concept that EAT and cardiac function are closely connected.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Metformin, which was developed from galegine, an anti-diabetic compound derived from <span class="elsevierStyleItalic">Galega officinalis</span>, is the first-line therapy to treat type 2 diabetic patients.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Ziyrek et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> add interesting findings to the growing literature on cardiac adiposity and heart disease. The authors demonstrated that metformin monotherapy significantly decreases EAT thickness and body mass index (BMI) after three months of therapy in newly diagnosed type 2 diabetes patients.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We read Ziyrek et al.’s study with interest, as it unveils new roles for metformin beyond its use as a first-line therapy for diabetes. The authors did not assess cardiovascular outcomes and no other visceral fat depots were measured in this study. Further work is needed to study and correlate the beneficial effects of metformin on EAT with possible positive cardiovascular outcomes in type 2 diabetic patients.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In addition, diabetic patients in Ziyrek et al.’s study were uncomplicated, and the results may not be applicable to diabetic patients with macrovascular complications. However, their results may warrant further studies in complicated and/or poorly controlled diabetic subjects.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Inflammation is the real culprit when it comes to triggering cardiovascular disease. This prospective observational study should have measured inflammatory markers, suggesting a mechanism of action and highlighting the importance of metformin in this context.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The main finding of the study was that metformin significantly reduces BMI and EAT thickness in newly diagnosed type 2 diabetic patients, reinforcing the use of metformin as a first line therapy for type 2 diabetes. Nevertheless, further research is needed to determine whether type 2 diabetic patients with macrovascular disease treated with metformin can achieve similar reductions in EAT thickness and volume. Also, modifications of the EAT transcriptome may open new avenues of treatment for cardiometabolic diseases. Indeed, EAT may serve as a therapeutic target for medications modulating adipose tissue in patients with cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">This study was supported by Fundação para a Ciência e a Tecnologia (Award IDs: PTDC/BIM-MET/4447/2014 and COMPETE: POCI-01-0145-FEDER-016784).</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Would Health Organization. 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| 2024 June | 22 | 22 | 44 |
| 2024 May | 31 | 18 | 49 |
| 2024 April | 22 | 26 | 48 |
| 2024 March | 43 | 21 | 64 |
| 2024 February | 34 | 18 | 52 |
| 2024 January | 34 | 29 | 63 |
| 2023 December | 31 | 35 | 66 |
| 2023 November | 25 | 28 | 53 |
| 2023 October | 12 | 12 | 24 |
| 2023 September | 19 | 17 | 36 |
| 2023 August | 13 | 15 | 28 |
| 2023 July | 17 | 10 | 27 |
| 2023 June | 24 | 11 | 35 |
| 2023 May | 29 | 29 | 58 |
| 2023 April | 19 | 11 | 30 |
| 2023 March | 22 | 18 | 40 |
| 2023 February | 24 | 12 | 36 |
| 2023 January | 19 | 12 | 31 |
| 2022 December | 29 | 18 | 47 |
| 2022 November | 40 | 31 | 71 |
| 2022 October | 30 | 16 | 46 |
| 2022 September | 20 | 41 | 61 |
| 2022 August | 22 | 31 | 53 |
| 2022 July | 26 | 38 | 64 |
| 2022 June | 23 | 26 | 49 |
| 2022 May | 19 | 24 | 43 |
| 2022 April | 23 | 34 | 57 |
| 2022 March | 26 | 43 | 69 |
| 2022 February | 23 | 37 | 60 |
| 2022 January | 12 | 21 | 33 |
| 2021 December | 20 | 26 | 46 |
| 2021 November | 15 | 26 | 41 |
| 2021 October | 18 | 40 | 58 |
| 2021 September | 16 | 28 | 44 |
| 2021 August | 19 | 33 | 52 |
| 2021 July | 16 | 17 | 33 |
| 2021 June | 16 | 23 | 39 |
| 2021 May | 23 | 39 | 62 |
| 2021 April | 35 | 34 | 69 |
| 2021 March | 28 | 17 | 45 |
| 2021 February | 35 | 13 | 48 |
| 2021 January | 44 | 22 | 66 |
| 2020 December | 29 | 14 | 43 |
| 2020 November | 22 | 9 | 31 |
| 2020 October | 14 | 12 | 26 |
| 2020 September | 12 | 4 | 16 |
| 2020 August | 22 | 6 | 28 |
| 2020 July | 11 | 6 | 17 |
| 2020 June | 11 | 15 | 26 |
| 2020 May | 27 | 2 | 29 |
| 2020 April | 26 | 4 | 30 |
| 2020 March | 20 | 11 | 31 |
| 2020 February | 73 | 20 | 93 |
| 2020 January | 47 | 7 | 54 |
| 2019 December | 17 | 6 | 23 |
| 2019 November | 27 | 5 | 32 |
| 2019 October | 20 | 4 | 24 |
| 2019 September | 14 | 9 | 23 |
Show all
