The Role of Perivascular Fat in the Diagnosis and Prognosis of Atherosclerosis

Cardiovascular diseases are the leading cause of morbidity and mortality globally, with serving as a significant yet complex risk factor in this regard. Obesity represents a set of conditions that consist of interactions between metabolic physiology,- as well as environmental-factors. Recent advances in adipose tissue biology have greater understanding into the distinct structures and functions of different adipose depots. This includes perivascular adipose tissue, which has been shown to engage bi-directional paracrine-, vasocrine- and endocrine-signalling with the vascular wall regulates the vascular redox state and atherogenesis. This has implications for how we the treatment of cardiometabolic disease, where novel insulin-sensitising agents reduce the risk of atherosclerosis through pleiotropic effects on the vascular wall, both and indirectly through modulating the adipose tissue secretome. Importantly, clinical modalities for visualisation of peri-vascular adipose tissue now exist that allow for accurate cardiovascular risk-stratification and raise the possibility of more targeted approaches in selected patients. In particular, the perivascular Fat Attenuation (an artificial intelligence enhanced cardiac computed tomography biomarker) has for the detection of inflammatory changes in perivascular adipose tissue that holds potential to improve secondary risk management. Consequently, this review how perivascular adipose tissue biology contributes to the development of, in addition to discussing how these developments can be detected using cardiovascular imaging techniques.