Fatty Heart in T2DM- A New Proposal in The Cardio Reno Metabolic Syndrome Continuum

Background and Objectives: Type 2 Diabetes Mellitus (T2DM) represents a major public health issue due to its prevalence and strong association with cardiovascular disease (CVD). Emerging evidence highlights Epicardial adipose tissue (EAT) as an active endocrine organ implicated in metabolic regulation, inflammation and thermogenesis. This article aims to scope the available evidence related to EAT´s role in the development and management of CVD in adults with T2DM. Materials and Methods: This scoping review followed PRISMA-ScR guidelines. Searches were conducted in Pubmed, Scopus and Cochrane using the terms “Epicardial Fat”, “Diabetes Mellitus” and “Cardiovascular Disease”. Systematic reviews, meta-analyses, clinical trials, and observational studies were included and screened. Articles with exclusively animal experiments, non-extractable data and no relevance with the research question were excluded. Results: 39 studies were included. Evidence showed that increased EAT thickness is associated with higher risk of coronary artery disease, ischemia, heart failure, and repolarization disorders. Interventions with SGLT2i and GLP1-RA reduced EAT’s volume and inflammatory profile. Data on dual GLP1/GIP agonists remains limited. Conclusions: Current evidence supports EAT as a potential biomarker and therapeutic target in cardiovascular management of T2DM patients. Even so, available clinical trials are limited, highlighting the need of more robust studies to establish its clinical value.