Correlation between Obesity and Epicardial Fat Volume in Patients With Coronary Artery Disease: From the Alternative Cardiovascular Bio-Imaging Markers Registry

Q: What are the key findings of this study?

Obesity demonstrated a non-linear relationship with epicardial fat volume in patients with coronary artery disease, with a positive correlation observed below a 200 ml inflection point (effect size 1.02).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary artery disease (CAD) (n=510). Intervention: Obesity (BMI ≥30 kg/m²) vs. Non-obese. Primary outcome: Relationship between obesity and epicardial fat volume (EFV) below a 200 ml inflection point (Effect size 1.02, 95% CI 1.02-1.03, p=<0.0001).

Q: What does this research mean for the field?

In patients with coronary artery disease, the relationship between obesity and epicardial fat volume is non-linear, exhibiting a positive correlation only below an inflection threshold of 200 ml. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate whether a consistent linear relationship exists between obesity and epicardial fat volume in individuals diagnosed with coronary artery disease.

Can Xu; Dongjing Wang

doi:10.18087/cardio.2025.1.n2782

January 31, 2025KardiologiiaOpen Access

Correlation between Obesity and Epicardial Fat Volume in Patients With Coronary Artery Disease: From the Alternative Cardiovascular Bio-Imaging Markers Registry

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Key result

Obesity linked to ~2% higher epicardial fat volume below a 200 ml inflection point.

Effect size 1.02
95% CI 1.02-1.03
P<0.0001
n=510

Why the study?

The study was conducted to investigate the relationship between obesity and epicardial fat volume in individuals diagnosed with CAD, specifically whether a consistent linear relationship exists.

Does obesity correlate with epicardial fat volume in patients with coronary artery disease?

Key Points

To investigate whether a consistent linear relationship exists between obesity and epicardial fat volume in individuals diagnosed with coronary artery disease.
Cross-sectional study evaluating 510 patients with coronary artery disease (398 non-obese, 112 obese) from the ALTER-BIO registry.
Controlled for confounders including age, sex, diabetes mellitus, smoking history, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, statin use, vasculopathy, and prior acute myocardial infarction using generalized additive and two-piecewise linear regression models.
Identified a non-linear relationship between obesity and epicardial fat volume, establishing a clinical inflection point at 200 ml (calculated at 203.3 ml).
Below an epicardial fat volume of 200 ml, a significant positive association with obesity was observed (OR = 1.02, 95% CI: 1.02–1.03, p < 0.0001).
Above the 200 ml threshold, the association was not statistically significant (OR = 0.99, 95% CI: 0.98–1.00, p = 0.1805).

Study Design

Type

Cross-Sectional (n=510)

Multicenter

No

Structured PICO

Does obesity correlate with epicardial fat volume in patients with coronary artery disease?

P

Population

510 patients with suspected obstructive cardiovascular disease referred for cardiac computed tomography angiography, with a mean age of 65.1 years and 23.5% female.

E

Exposure

Obesity, defined as Body Mass Index (BMI) ≥ 30 kg/m²

C

Comparator

Non-obesity (BMI < 30 kg/m²)

O

Outcome

Relationship between epicardial fat volume (EFV) and obesity, adjusted for confounding factorssurrogate

Main Result

Odds Ratio: 1.02 (95% CI 1.02–1.03)

p-value: p=<0.0001

The relationship between epicardial fat volume and obesity in CAD patients is non-linear, which should be considered in risk stratification and prognostic modeling.

Limitations

Cross-sectional study design limits ability to draw causal connections between exposure and outcome.
Sample population was described in the limitations as solely Chinese, which may limit generalizability to other ethnic groups (though methods state an Italian registry).
Limitations in raw data prevented exploration of the relationship between atrial fibrillation and heart rate or mortality.
Potential selection bias as participants lacking data on both obesity and EFV were excluded.
Cross-sectional design limits causal inference
Sample population stated as Chinese in limitations (despite Italian registry source), potentially limiting generalizability
Unable to explore outcomes like mortality or atrial fibrillation
Potential selection bias from missing data exclusions

Implication

Non-linear obesity-EFV association may refine CAD risk models; cross-sectional data leaves causal and predictive roles open for prospective validation.

Abstract

BACKGROUND: The primary objective was to investigate the relationship between and obesity and epicardial fat volume (EFV) in individuals diagnosed with coronary artery disease (CAD), with the aim of determining whether a consistent linear relationship exists among these factors. MATERIAL AND METHODS: This cross-sectional study involved a total of 510 participants. To explore the relationship between EFV and obesity in CAD patients, we controlled for potential confounding variables, including age, sex, diabetes mellitus, smoking history, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, statin use, vasculopathy, and prior acute myocardial infarction. RESULTS: After adjusting for confounding factors, a non-linear relationship was observed between obesity and EFV, with an inflection point identified at 200 ml. The effect sizes and their respective confidence intervals were 1.02 (CI: 1.02-1.03) and 0.99 (CI: 0.98-1.00) on either side of this inflection point. Below a EFV of 200 ml, a positive correlation between obesity and EFV was apparent. CONCLUSION: The relationship between obesity and EFV in CAD patients is non-linear, and this should be considered when developing prognostic models for CAD. The findings suggest that the relationship between EFV and obesity is more complex than previously thought and warrants further investigation to better understand its implications for both CAD and obesity risk assessment and management.

Discussion

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Cite This Study

Xu et al. (2025) conducted a cross-sectional in Coronary artery disease (CAD) (n=510). Obesity (BMI ≥30 kg/m²) vs. Non-obese was evaluated on Relationship between obesity and epicardial fat volume (EFV) below a 200 ml inflection point (Effect size 1.02, 95% CI 1.02-1.03, p=<0.0001). Obesity demonstrated a non-linear relationship with epicardial fat volume in patients with coronary artery disease, with a positive correlation observed below a 200 ml inflection point (effect size 1.02).

synapsesocial.com/papers/6a62bc047fd4bc433b96acb2 https://doi.org/10.18087/cardio.2025.1.n2782

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Correlation between Obesity and Epicardial Fat Volume in Patients With Coronary Artery Disease: From the Alternative Cardiovascular Bio-Imaging Markers Registry

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Correlation between Obesity and Epicardial Fat Volume in Patients With Coronary Artery Disease: From the Alternative Cardiovascular Bio-Imaging Markers Registry

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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