Association of epicardial adipose tissue attenuation with coronary atherosclerosis in patients with a high risk of coronary artery disease

Background and aims: Density may indicate some tissue characteristics and help reveal the role of epicardial adipose tissue (EAT) in coronary artery disease (CAD). Therefore, we assessed the association of EAT density with the coronary artery plaque burden in patients presenting with chest pain. Methods: This retrospective cohort study comprised 614 patients (mean age 61 +/- 9 years, 61% males) with a high cardiovascular disease risk, who underwent cardiac computed tomography angiography. Density was reflected as attenuation. Results: EAT attenuation was significantly associated with EAT volume with a negative Pearson's correlation coefficient and gradually increased across coronary artery calcium (CAC) scores of 0, 1-100, 101-400 and > 400. EAT attenuation was tightly associated with CAD risk factors, including age, sex, BMI, total cholesterol, neutrophil to lymphocyte ratios and CAC score. The association between EAT attenuation and CAC score was strengthened after adjusting for multivariable indices (OR 1.21, 95% CI 1.05-1.40, p=0.01) and further adjusting for EAT volume (OR 1.26 95% CI 1.06-1.51, p<0.01). However, EAT attenuation was associated only with CAD presence (OR 1.32, 95% CI 1.02-1.69, p<0.05), CAC presence (OR 1.28, 95% CI 1.02-1.60, p<0.05), segment involvement score (OR 1.19, 95% CI 1.01-1.40, p<0.05) and segment stenosis score (OR 1.19, 95% CI 1.01-1.40, p<0.05) in the EAT volume-and multivariable-adjusted model. Additionally, EAT attenuation was not associated with significant coronary artery lesions and triple-vessel plaques. Conclusions: Higher EAT attenuation is associated with a higher risk of CAD.