Association of epicardial adipose tissue with metabolic risk factors on cardiovascular outcomes: serial coronary computed tomography angiography study

Abstract

Background/aims: Epicardial adipose tissue (EAT) shares pathophysiological properties with other visceral fats and potentially triggers local inflammation. However, the association of EAT with cardiovascular disease (CVD) is still debatable. The study aimed to observe the changes and associations in EAT and risk factors over time, as well as to investigate whether EAT was associated with CVD.

Methods: A total of 762 participants from Seoul National University Hospital (SNUH) and SNUH Gangnam Center were included in this study. EAT was measured using coronary computed tomography angiography.

Results: Baseline EAT level was positively associated with body mass index (BMI), calcium score, atherosclerotic cardiovascular disease (ASCVD) 10-year risk score, glucose, triglycerides (TG)/high-density lipoprotein (HDL), but not with total cholesterol, low-density lipoprotein (LDL). At follow-up, EAT levels increased in all groups, with low EAT groups demonstrating a significant increase in EAT per year. Change in EAT was associated with a change in BMI, TG/HDL, and glucose, while changes in LDL, calcium score, and ASCVD 10-year risk score were not associated. Although calcium score and ASCVD 10-year risk score were associated with CVD events, baseline information of EAT, baseline EAT/body surface area, or EAT change was not available.

Conclusion: Metabolic risks, e.g., BMI, TG/HDL, and glucose, were associated with EAT change per year, whereas classical CVD risks, e.g., LDL, calcium score, and ASCVD 10-year risk score, were not. The actual CVD event was not associated with EAT volume, warranting future studies combining qualitative assessments with quantitative ones.

Keywords: Adipose tissue; Cardiovascular disease; Risk factors; Serial study.

Figure 1.

The flow of participants through the study. CABG, coronary artery bypass grafting; CCTA, coronary computed tomography angiography; EAT, epicardial adipose tissue; PCI, percutaneous coronary intervention.

Figure 2.

Impact of EAT change per year on change of clinical characteristics (Scatter plots). Scatter plots display associations between EAT change per year and BMI (A), TG/HDL (C), and glucose change (E). In comparison, they did not display a correlation between EAT change per year and LDL (B), calcium score (D), and ASCVD 10-year risk score change (F). R2 and p values were calculated through simple regression analysis. ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; EAT, epicardial adipose tissue; HDL, high-density lipoprotein; HU, Hounsfield unit; LDL, low-density lipoprotein; TG, triglyceride.

Figure 3.

ROC curve for the impact of clinical characteristics on CVD event. ASCVD, atherosclerotic cardiovascular disease; AUC, area under the curve; BSA, body surface area; CVD, cardiovascular disease; CI, confidence interval; EAT, epicardial adipose tissue; ROC, receiver operating characteristic.

Figure 4.

CVD event rate with EAT change per year grouped by risk prediction markers. Analyzed CVD event and EAT change per year grouped by calcium score (A) and ASCVD 10-year risk score (B). ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; EAT, epicardial adipose tissue; HU, Hounsfield units.