Sci Rep. 2026 May 15. doi: 10.1038/s41598-026-53191-2. Online ahead of print.
ABSTRACT
Epicardial adipose tissue (EAT) is an emerging cardiometabolic risk factor in type 2 diabetes mellitus (T2DM). While SGLT-2 inhibitors (SGLT-2i) offer cardiovascular benefits, their specific effects on EAT and left ventricular (LV) remodeling and function in Asian populations remain understudied. This study investigated the relationship between SGLT-2i on cardiometabolic parameters, EAT thickness and LV function in Malaysian patients with T2DM and coronary artery disease (CAD). A total of 360 patients with T2DM and CAD were divided into non-SGLT-2i and SGLT-2i groups. Anthropometric, cardiometabolic, and echocardiographic measurements were analyzed at baseline and post-6 months for 302 patients who competed the study (n = 151 per group). Both groups showed improvements in glycemic control (fasting blood glucose - 1.7 vs. - 2.6 mmol/L; HbA1c - 0.3% vs. - 0.6%; all p < 0.001). Broader cardiometabolic benefits were observed predominantly among SGLT-2i group, including greater reductions in body mass index (- 0.7 vs. - 0.3 kg/m2) and serum lipid concentrations (all p < 0.001), a marked decrease in EAT thickness (-1 .5 mm vs. + 0.6 mm, p < 0.001), and concomitant improvements in left ventricular structure, with reductions in LV mass (- 20 vs. + 7.8 g) and increased LV ejection fraction (+ 4.6% vs. - 1.0%) (all p ≤ 0.01). Within the SGLT-2i group, EAT reduction was associated with lower body weight and BMI (p < 0.05) but was independent of glycemic changes. Reductions in body weight and BMI were associated with improvements in LV diameter and mass (p < 0.05) and although not directly mediated by changes in EAT. Beyond glycemic control, SGLT-2i was associated with reduced EAT thickness and improved LV remodeling and function in Malaysian T2DM patients with CAD. The reduction in EAT thickness specifically was associated with lower body weight and BMI. These findings provide Asian population-specific evidence with distinct cardiometabolic and adiposity traits.
PMID:42141141 | DOI:10.1038/s41598-026-53191-2