Epicardial Fat Thickness as a Marker of Coronary Artery Disease in Diabetics: A Single Center Study

BACKGROUND: Epicardial fat thickness (EFT) is a visceral fat depot with pro-inflammatory properties, located adjacent to coronary vessels, and has been proposed as a marker of coronary artery disease (CAD). This study aimed to evaluate the association between EFT and the presence and severity of CAD in patients with type 2 diabetes mellitus. METHODS: This retrospective study was conducted at the Abbas Institute of Medical Sciences (AIMS) between January 2020 and March 2025 (Study ID: AIMS/25/007). A total of 2340 diabetic patients (mean age: 58.3 ± 9.6 years) were included. EFT was measured using transthoracic echocardiography, and CAD presence and severity were assessed via coronary angiography. Logistic regression analysis was used to evaluate associations, with results expressed as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Elevated EFT (≥ 5 mm) was observed in 1281 patients (54.7%). CAD was present in 1121 individuals (47.9%), with significantly higher rates in those with elevated EFT (65.7% vs. 26.3%, p < 0.001). EFT ≥ 5 mm was associated with a 5.38-fold increased odds of CAD (95% CI: 4.59-6.30, p < 0.001). Moreover, patients with elevated EFT had a significantly higher prevalence of multi-vessel CAD, indicating a correlation between EFT and disease severity. CONCLUSIONS: In diabetic patients, elevated EFT is significantly associated with both the presence and severity of CAD. EFT measurement via echocardiography may serve as a simple, noninvasive tool for cardiovascular risk stratification and early intervention planning.