Epicardial adipose tissue volume is related to subclinical atherosclerosis and major adverse cardiac events in asymptomatic subjects

Introduction Recent research has shown that Individuals with a higher risk of coronary heart disease (CHD) have elevated coronary artery calcium score (CACS) and a significant probability of cardiovascular (CV) events. Other scientific works have demonstrated the link between increased epicardial adipose tissue (EAT) and CHD. The association between high EAT and CV events is not well-known. Objective We propose investigating whether high CACS and EAT volume correlate. Additionally, we study the role of EAT volume alone in predicting overall major cardiovascular events (MACE) in our population. Methods This prospective study included 1024 participants (58.3±8.4 years; 75.6% male) from a Southern European population without apparent CAD and followed during an extended period (average 7.3±6.0 years). All demographic, biochemical, CV risk factors and clinical data were performed. Non-contrast CT images obtained CACS and EAT. The EAT volume was performed using a postprocessing workstation, "TeraRecon Aquarius Workstation", and the EAT cut-off value was calculated (7.37 cm3). Values above and below were considered. CACS categories were determined as 0, 1-99 and ≥100. Data were displayed as mean and standard deviation (SD). ANOVA test compared the CACS categories with EAT volume. Cox regression analysis, entering EAT volume, estimated variables independently associated with prognosis after adjustment to co-variates (age, smoking, type 2 diabetes, glomerular filtration rate (GFR), systolic and diastolic blood pressure, pulse wave velocity (PWV), leucocytes, fibrinogen and high-sensitivity C-reactive protein (hsCRP)). Kaplan-Meier estimated the events-free survival. Statistical significance was defined as p<0.05, and all analyses were performed using SPSS statistical software version 25.0. Results Increased EAT was associated with higher CACS categories (p<0.0001). After Cox regression analysis, the increased EAT volume was associated with MACE with an adjusted hazard ratio of 1.95 (95% CI: 1.02-3.75; p=0.044). Observing the Kaplan-Meier estimator, the event curves showed divergence early on, with individuals with higher EAT volumes presenting worse survival than individuals with a lower EAT volume. Conclusion Our findings demonstrated that epicardial adipose tissue and CACS categories are correlated significantly. When used independently, EAT volume is a significant risk factor for MACE, and subjects with a high EAT volume had a worse cardiovascular prognosis.