Increased epicardial adipose tissue is associated with coronary artery disease and major adverse cardiovascular events

Background: Increased-epicardial-adipose tissue (EAT) is associated with the presence and severity of subclinical-atherosclerosis. This study investigates the long-term clinical-outcome of subjects with and without increased-EAT. Methods: Two hundred and forty-five subjects, aged 61 +/- 9 years and 34% women underwent clinically-indicated computed-tomography-angiography (CTA), and body-surfacearea adjusted EAT was measured and were followed prospectively. CTA-diagnosed coronary-arterydisease (CAD) was defined as obstructive (luminal-stenosis >= 50%), non-obstructive (luminal-stenosis: 1 -49%) and zero-obstruction. Major-adverse-cardiac-event (MACE) was defined as myocardial-infarction or cardiovascular-death. Results: EAT increased significantly from subjects with zero-obstructioncoronaries (93 +/- 37 cm(3)/m(2)) to non-obstructive-CAD (132 +/- 25 cm(3)/m(2)) to obstructive-CAD (145 +/- 35 cm(3)/m(2)) (P = 0.01). During the 48-month follow-up, the event-rate was 8.6% (21). The event free survival-rate decreased significantly from 99% in the lowest-quartile to 86.6% in the highestquartile of EAT. After adjustment for risk-factors, the hazard ratio of MACE was 1.4, 3.1 and 5.7 in lower mid-, upper mid-and highest-quartiles of EAT as compared to lowest-quartile of EAT (P < 0.05). Conclusion: Increased EAT is directly associated with CAD and predicts MACE independent of the age, gender and conventional-risk-factors. (C) 2014 Elsevier Ireland Ltd. All rights reserved.