A recent study published in JACC: Cardiovascular Imaging found that high epicardial adipose tissue volume (EATv) is independently associated with the presence and progression of coronary artery disease (CAD), highlighting its value as a potential risk‑stratification marker for major cardiovascular events (MACE) and a therapeutic target for earlier or more intensive intervention.

The study included 773 patients from the multinational, observational PARADIGM registry. Annalisa Filtz, MD, et al., used serial coronary CT angiography to assess plaque volume (PV), percent atheroma volume (PAV) and plaque progression (PP). CAD was defined as any plaque, rapid plaque progression (RPP) was defined as annual PAV increase ≥1% EATv and advanced plaque characteristics were measured.

The authors used multivariable models to evaluate the relationships between EATv, plaque, PP and RPP, and examined the prognostic value of PP and RPP for predicting MACE.

Among included patients (mean age of 62 years, 43% women), patients with, vs. those without, CAD had significantly higher EATv than (95 cm3 vs. 84 cm3; p<0.001). PV, PAV and calcified and noncalcified plaque components progression was significantly greater in the highest ETv tertile vs. lowest tertile. Of note, the prevalence of PP and RPP also increased across EATv tertiles.

The multivariable analyses showed that high EATv was independently associated with PP, RPP and plaque across two different models adjusted for age, sex, BMI, diabetes, dyslipidemia, hypertension, hypertriglyceridemia, smoking and statin therapy. The 10‑year MACE‑free survival was lower in patients with PP and RPP (log‑rank p=0.006 and p<0.001, respectively).

Despite study limitations including selection bias and a potential lower-risk CAD cohort, “these findings suggest that EATv may represent a more robust marker for longitudinal PP whereas global [EAT density] has inherent methodological and spatial limitations in this context, although further studies are warranted.”