Could epicardial fat measurement play an additional role in predicting cardiovascular events based on coronary artery calcium score?

Abstract Introduction Recent research has shown that high Epicardial Adipose Tissue (EAT) and Coronary Artery Calcium Score (CACS), assessed by cardiac computed tomography (CT), are associated with patient prognosis and risk of adverse cardiovascular (CV) outcomes. However, considering CACS alone, it is unclear whether EAT added increases in predicting the risk of events. Objective Study the role of Epicardial Adipose Tissue in cardiovascular risk when CACS influence is present. Methods A prospective study with 1024 healthy participants (58.3±8.4 years; 75.6% male) followed during an average of 7.3±6.0 years. Non-contrast CT images for CACS were obtained at baseline, and the EAT volume was analyzed. Kaplan-Meier estimator was used to assess the additional predictive value of EAT relative to the CACS in four models for the risk of all-cause CV adverse events. A Cox regression analysis was performed with the CACS and EAT combination and adjusted for all other covariables. Results After an extended follow-up period, 41 participants (4%) had CV events. Kaplan-Meier, stratified by EAT and CACS, showed the lowest EAT and CACS had the best probability of survival, and those with higher EAT volume and CACS had the worst survival. After Cox regression analysis, increased EAT and CACS were associated with an adjusted hazard ratio of 5.51 (95% CI: 2.33 to 13.00; p0.0001), predicting CV events. Conclusion Increased EAT volume is associated with more CV events, probably due to atherosclerosis advance. There is an incremental predictive value when the increased EAT volume is added to the increased CACS in predicting CV events. Strategies to reduce EAT volume may decrease subclinical atherosclerosis and improve outcomes with adequate measures like physical exercise, proper diet and pharmaceutical intervention.