Differential Association of Regional Adipose Tissue Deposit with Cardiovascular-Kidney-Metabolic Syndrome

INTRODUCTION: Cardiovascular-kidney-metabolic (CKM) syndrome is a condition characterized by the interplay between cardiovascular disease, kidney disease, diabetes, and obesity, resulting in adverse health outcomes. This study aimed to investigate the differential associations between various adipose tissue types and the progression of CKM syndrome, as well as their relationship with the individual components of the syndrome. METHODS: We conducted a retrospective review of 441 individuals with preserved left ventricular (LV) systolic function who underwent both transthoracic echocardiography and abdominal computed tomography. LV structural and functional parameters, along with the thickness of epicardial adipose tissue (EAT), perirenal adipose tissue (PAT), and subcutaneous adipose tissue (SAT), were assessed through these imaging modalities. Additionally, the triglyceride and glucose (TyG) index was evaluated as a marker of insulin resistance, while glomerular filtration rate (GFR) was estimated to assess kidney function. RESULTS: EAT and PAT demonstrated a progressive increase in thickness with advancing stages of CKM syndrome, whereas body mass index and SAT did not show similar trends. EAT was predominantly associated with markers of LV diastolic dysfunction, while PAT was uniquely associated with GFR, independent of other adipose tissue. Furthermore, the TyG index was independently correlated with the thickness of both EAT and PAT, but not with SAT thickness. CONCLUSION: Heart, kidney, and metabolic disorders associated with CKM syndrome demonstrated varying correlations depending on the specific regional adipose tissue depot. EAT and PAT were identified as key regional adipose tissue linked to the progression of CKM syndrome.