March 6, 2026
Epicardial Adipose Tissue, Coronary Plaque Progression, and Major Adverse Cardiovascular Events: A Multicenter Study.
Key result
High epicardial adipose tissue volume is linked to CAD presence and progression.
- P=0.013
- n=773
The journal published a graphical abstract
Its licence doesn't allow us to show a copy here.
Why the study?
Does high epicardial adipose tissue volume predict coronary plaque progression and major adverse cardiovascular events in patients undergoing serial coronary CTA?
Key Points
- To evaluate the relationship between epicardial adipose tissue volume, coronary artery plaque progression, and subsequent major adverse cardiovascular events.
- Evaluated 773 patients (mean age 62 ± 9 years; 324 women [43%]) from the multicenter PARADIGM registry who underwent serial coronary computed tomography angiography.
- Quantified epicardial adipose tissue volume (EATv), plaque volume, and percent atheroma volume (PAV), defining rapid plaque progression as an annual PAV increase ≥1%.
- Patients with coronary artery disease had higher median EATv than those without (95 cm³ [Q1–Q3: 72.5–127] vs 83.5 cm³ [Q1–Q3: 63–112.8]; P < 0.001), and the highest EATv tertile experienced significantly greater progression in plaque volume (P = 0.001) and PAV (P = 0.028) than the lowest tertile.
- Rates of plaque progression increased across EATv tertiles (T1: 78.9% vs T2: 83.9% vs T3: 88.5%; P = 0.013) as did rapid plaque progression (T1: 25.2% vs T2: 32.3% vs T3: 36.4%; P = 0.021), both of which were associated with lower 10-year event-free survival (log-rank P = 0.006 and P < 0.001, respectively).
Study Design
Type
Cohort (n=773)
Multicenter
Yes
Structured PICO
Does high epicardial adipose tissue volume predict coronary plaque progression and major adverse cardiovascular events in patients undergoing serial coronary CTA?
P
Population
773 patients (mean age 62 years, 43% women) from the PARADIGM registry undergoing serial coronary computed tomography angiography to assess plaque progression.
E
Exposure
High epicardial adipose tissue volume (EATv)
C
Comparator
Low epicardial adipose tissue volume (EATv)
O
Outcome
Coronary plaque progression (PP), rapid plaque progression (RPP, defined as annual percent atheroma volume increase ≥1%), and 10-year MACE-free survivalsurrogate
Main Result
Absolute Event Rate: 88.5% vs 78.9%
p-value: p=0.013
Ask about this paper
Answers are grounded in this paper and cite their sources.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our findings add a new layer to the importance of EAT as a risk marker for not only plaque presence but also plaque progression. Accumulating evidence supports its association with the presence of CAD, a relationship we and others have demonstrated across diverse patient populations.”
“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.”
“We have a plethora of imaging markers that show the same thing. I wonder in what way this one is giving you a better predictability than existing imaging markers that have been described before.”
Implication
High epicardial adipose tissue volume is independently associated with coronary plaque progression, which in turn predicts lower 10-year MACE-free survival.
Abstract
BACKGROUND: Epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD), but its relationship with plaque progression (PP)-a predictor of major adverse cardiovascular events (MACE)-remains unclear. OBJECTIVES: This study examines the interplay between EAT, PP, and subsequent MACE. METHODS: From the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry, serial coronary computed tomography angiography assessed plaque volume (PV), percent atheroma volume (PAV), and PP. Rapid plaque progression (RPP) was defined as annual PAV increase ≥1%. EAT volume (EATv) and advanced plaque characteristics were measured. CAD was defined as any plaque. Multivariable models assessed associations between EATv, plaque, PP, and RPP. The prognostic value of PP and RPP for MACE was evaluated. RESULTS: Among 773 patients (mean age 62 ± 9 years; 324 women [43%]), those with CAD had significantly higher EATv than did those without CAD (95 cm3 [Q1-Q3: 72.5-127 cm3] vs 83.5 cm3 [Q1-Q3: 63-112.8 cm3]; P < 0.001). Progression of PV, PAV, and calcified and noncalcified plaque components was significantly greater in the highest (third) EATv tertile (T3) than in T1 (PV: P = 0.001; PAV: P = 0.028; calcified component: P = 0.025; noncalcified component: P = 0.022). The prevalences of PP (T1: 78.9% vs T2: 83.9% vs T3: 88.5%; P = 0.013) and RPP (T1: 25.2% vs T2: 32.3% vs T3: 36.4%; P = 0.021) also increased across EATv tertiles. In multivariable analyses, high EATv was independently associated with plaque, PP, and RPP across 2 different models adjusted for age, sex, body mass index, diabetes, dyslipidemia, hypertension, hypertriglyceridemia, smoking, and statin therapy. Patients with PP and RPP had lower 10-year MACE-free survival (log-rank; P = 0.006 and log-rank; P < 0.001, respectively). CONCLUSIONS: High EATv is independently associated with CAD presence and progression, underscoring its potential as a marker for risk stratification and a therapeutic target for earlier or more intensive treatment.
Discussion
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Cite This Study
Filtz et al. (2026) conducted a cohort in Coronary artery disease (n=773). High epicardial adipose tissue volume vs. Low epicardial adipose tissue volume was evaluated on Plaque progression (p=0.013). High epicardial adipose tissue volume was independently associated with increased plaque progression (88.5% in highest vs 78.9% in lowest tertile; P=0.013) and rapid plaque progression.