Iglay et al. [Citation1] conducted a comprehensive cross-sectional analysis entitled “Comorbidities in Type 2 Diabetes Patients with and without Atherosclerotic Cardiovascular Disease: A Retrospective Database Analysis.” They [Citation1] described the comorbidities of 1,522,526 type 2 diabetes [T2DM] patients with and without atherosclerotic cardiovascular disease (ASCVD). The patients with ASCVD tended to be older and had T2DM for longer, compared with T2DM patients without ASCVD [Citation1].
Alonso-Moran et al. [Citation2] found that the odds ratio for coronary heart disease (CHD), stroke and heart failure all increased with each 5-year age category compared with a reference group aged 35-39 years (p < 0.001). Duration of DM also increases the risk of CHD death independently of coexisting risk factors (RFs) [Citation3] and ASCVD affects approximately 32.2% of all T2DM patients [Citation4]. Addressing the ASCVD burden in DM should improve quality of life and reduce premature death [Citation5].
Iglay et al. [Citation1] found that the prevalence of overweight/obesity was similar in DM patients with and without ASCVD (80.5 vs 80.6%). However, there is evidence that certain fat depots are important determinants of ASCVD risk. DM is associated with abnormal peri-organ and intra-organ fat (APIFat) deposition which probably increases the risk of vascular events [Citation6]. Furthermore, decreasing epicardial/pericardial fat may play a role in CHD prevention in patients with DM [Citation7]. Glucagon-like peptide-1 receptors agonists and sodium-glucose co-transporter-2 inhibitors induce weight loss and have ASCVD benefits, but it is not clear which fat depots are most affected [Citation8].
ASCVD and non-alcoholic fatty liver disease (NAFLD) share common drivers, most notably insulin resistance and other components of metabolic syndrome (MetS) [Citation9]. A limitation of the Iglay et al. study [Citation1] is the omission of the assessment of the prevalence of MetS.
Iglay et al. [Citation1] remind us that there is still much to do to fully understand the links between RFs and the development of ASCVD. In the future, in addition to conventional RFs, assessing APIFat (including NAFLD) may help better identify T2DM patients at greatest risk of ASCVD. More studies are needed to support or refute this hypothesis.
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The authors and peer reviewers of this manuscript have no relevant financial or other relationships to disclose.
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References
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