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Epicardial Adipose Tissue, Coronary Plaque Progression, and Major Adverse Cardiovascular Events: A Multicenter Study
Annalisa Filtz1, Daniel Lorenzatti1, Andrea Scotti1
1Cardiology Division, Montefiore Health System/Albert Einstein College of Medicine, Bronx, New York, USA.
JACC. Cardiovascular Imaging
|March 10, 2026
Summary
High epicardial adipose tissue (EAT) volume is linked to coronary artery disease (CAD) presence and progression. This finding highlights EAT as a potential marker for risk stratification and a target for earlier, more intensive treatment.
Area of Science:
- Cardiology
- Radiology
- Metabolic Syndrome
Background:
- Epicardial adipose tissue (EAT) is linked to coronary artery disease (CAD).
- The relationship between EAT and plaque progression (PP), a predictor of major adverse cardiovascular events (MACE), is not fully understood.
Purpose of the Study:
- To investigate the association between EAT volume (EATv) and CAD.
- To examine the relationship between EATv, plaque progression (PP), and subsequent MACE.
Main Methods:
- Utilized data from the PARADIGM registry, including serial coronary computed tomography angiography.
- Assessed plaque volume (PV), percent atheroma volume (PAV), and PP, defining rapid plaque progression (RPP) as annual PAV increase ≥1%.
- Measured EAT volume (EATv) and advanced plaque characteristics, performing multivariable analyses to assess associations and prognostic value for MACE.
Main Results:
- Patients with CAD had significantly higher EATv than those without.
- Higher EATv tertiles were associated with greater progression in plaque volume and components.
- Prevalence of PP and RPP increased across EATv tertiles, with high EATv independently associated with plaque presence, PP, and RPP.
- PP and RPP were linked to lower 10-year MACE-free survival.
Conclusions:
- Elevated EAT volume is independently associated with the presence and progression of CAD.
- EATv shows potential as a biomarker for cardiovascular risk stratification.
- Targeting EAT may offer a strategy for earlier or more intensive treatment of CAD.
Keywords:
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