Non-alcoholic fatty liver disease (NAFLD) is a growing endemic which is methodically associated to metabolic syndrome and insulin resistance with a prevalence of 69–87 % in the setting of diabetes. Data supports the association between NAFLD and increased CV risk independent of traditional risk factors, comprising those shared with metabolic syndrome. Analysis of NAFLD in diabetic individuals might permit aggressive CV risk factor alteration and embattled therapy for NAFLD. 

Epicardial adipose tissue (EAT) is a storehouse of fats that is developing as a unique indicator of subclinical CVD, and, like CAC score, it can be resultant of a non-contrast cardiac computed tomography (CT). Several studies have confirmed that EAT delivers incremental prognostic information over and above CAC and traditional risk factors for the calculation of major adverse cardiac events.

In asymptomatic T2D individuals, EAT volume was meaningfully higher in those with NALFD associated to those without NAFLD. Given that MR imaging-PDFF and extent of liver fibrosis determined by MRE were individually related with EAT in diabetics, liver fat content and fibrosis may upsurge CV risk, and as a result, documentation of even mild forms of NAFLD in diabetic individuals may warrant treatment and aggressive risk factor modification to reduce cardiovascular risk.

EAT volume is greater in diabetic individuals with NAFLD. Liver fat content is completely connected with EAT. Liver fat content and liver fibrosis were autonomously associated with EAT. Higher liver fat content and fibrosis may adversely affect cardiovascular risk.

Source: Eur Radiol. 2018 Apr; 28(4): 1345–1355.