From depigmentation to dysmetabolism: epicardial fat thickness and atherogenic lipid ındices in vitiligo

Abstract

Background Systemic metabolic and cardiovascular alterations have been reported in vitiligo, yet Epicardial Fat Thickness (EFT) and echocardiographic structural changes remain understudied. This study compares these parameters between vitiligo patients and healthy controls and examines their association with disease severity. Methods In this case-control study, 90 adults with vitiligo and 90 matched controls underwent standardized transthoracic echocardiography with multi-window EFT assessment (parasternal, apical, subcostal). Clinical and lipid indices were recorded. Associations with disease severity were evaluated using Spearman correlations and multivariable linear regression, adjusting for age, sex, BMI, blood pressure, LDL, fibrinogen and CRP. ROC analyses assessed the discriminatory value of biomarkers for high-severity disease. Results Vitiligo patients demonstrated significantly higher EFT across all echocardiographic windows (p <= 0.002) and larger left atrial and ascending aorta diameters (p <= 0.010). In multivariable models, vitiligo independently predicted mean EFT (B = 0.82, p = 0.003) and aortic valve gradient (B = 1.13, p = 0.019). VASI/BSA correlated strongly with triglycerides, VLDL, TG/HDL ratio, and atherogenic index of plasma (r = 0.574-0.681, all p < 0.001), and with both aortic gradient and EFT. The acrofacial phenotype exhibited the most adverse metabolic and echocardiographic profiles. Study limitations Comorbidity-based exclusion criteria enhance internal validity but limit generalizability, and systematic lifestyle data were unavailable. Conclusions Vitiligo is independently associated with increased epicardial fat, adverse triglyceride-related atherogenic indices, and subtle cardiac structural alterations, even without overt comorbidities. These findings are most pronounced in patients with higher VASI severity and acrofacial or widely distributed disease, supporting consideration of cardiovascular assessment in these subgroups.