Epicardial Adipose Tissue as Predictor of Coronary Artery Disease. A New Parameter to Stratify Cardiovascular Risk?

The association between visceral adipose tissue and cardiovascular disease has been clearly established. Likewise, it has been determined that ectopic adiposity is associated with a higher cardiovascular risk compared to subcutaneous adiposity. In this context, multiple investigations have evaluated the role of epicardial adipose tissue (EAT) in cardiovascular disease. EAT is located between the myocardial surface and the visceral layer of the pericardium, and can be quantified by noninvasive techniques such as echocardiography, computed tomography, or magnetic resonance imaging. The EAT is not simply a storage organ. Currently, it is considered to be a metabolically active tissue capable of secreting multiple adipokines that act through different paracrine, endocrine, vasocrine and/or autocrine signaling pathways. Current evidence suggests that EAT may be a contributing factor in the pathogenesis of coronary heart disease, as well as being associated with its severity and progression. In this sense, some authors have postulated EAT as a new cardiovascular risk factor and as a potential therapeutic target. The aim of this review is to analyze the association between EAT and cardiovascular disease, mainly coronary artery disease.