Associations between brown adipose tissue activity, serum lipid profiles, and cardiovascular events: insights from 18F-fluorodeoxyglucose PET/computed tomography analysis

Objective This study investigated the associations between brown adipose tissue (BAT) metabolic parameters, serum lipid profiles, and cardiovascular disease (CVD) events. Methods A retrospective cohort study involving 13 530 patients who underwent 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography between November 2019 and March 2024 was conducted to evaluate semiquantitative BAT indices, including the maximum standardized uptake value (B-SUV max ), total metabolic volume (TBMV), and total BAT glycolytic activity (TBG), as well as their associations to lipid profiles [total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and TC/HDL-C and LDL-C/HDL-C ratios) and CVD outcomes. Propensity score matching was applied, resulting in a comparison group of 74 BAT-positive patients and 148 BAT-negative controls. Results BAT-positive individuals exhibited significantly higher HDL-C levels ( P = 0.005) and lower TC/HDL-C ( P = 0.006) and LDL-C/HDL-C ( P = 0.014) ratios compared with controls, while no significant differences were observed in triglyceride, TC, or LDL-C levels. TBG showed the strongest correlations with HDL-C ( r = 0.256, P < 0.001), TC/HDL-C ( r = −0.223, P < 0.001), and LDL-C/HDL-C ( r = −0.195, P = 0.004), outperforming B-SUV max and TBMV. Patients exhibiting BAT had a lower incidence of CVD events compared to those without detectable BAT ( P = 0.018). Multivariate logistic regression analysis showed that the presence of BAT is an independent predictor of CVD events. Conclusion TBG is a moderate biomarker reflecting HDL-C levels and the ratios of TC/HDL-C and LDL-C/HDL-C, while detectable BAT activity independently correlates with reduced CVD risk, highlighting its potential for cardiovascular risk stratification.