Epicardial Fat Emerging as a New CAD Risk Marker

New research suggests that higher volumes of epicardial adipose tissue (EAT)—the fat surrounding the heart—are closely linked to both the presence and progression of coronary artery disease (CAD).

In a recent analysis from the PARADIGM registry, published in JACC: Cardiovascular Imaging, serial coronary CT angiography (CCTA) scans from over 700 patients showed that greater EAT volume was associated with more frequent and faster plaque progression, including both calcified and noncalcified plaque. Over an average of eight years, participants with the highest EAT volumes were significantly more likely to experience plaque progression and rapid plaque progression, which correlated with higher long-term cardiovascular risk.

While EAT volume itself was not independently predictive of major adverse cardiovascular events (MACE) after adjustment for traditional risk factors, it remained a strong indicator of plaque burden and progression. Importantly, EAT can be measured automatically from both contrast and noncontrast CT images using AI-based tools, making it an accessible imaging biomarker.

EAT may also represent a modifiable risk factor, as therapies like statins and GLP-1 receptor agonists have been shown to reduce epicardial fat volume in prior studies. This supports its potential role as a clinically actionable biomarker in coronary prevention and disease monitoring.

Still, questions remain about how much additional predictive value EAT offers compared with current noninvasive imaging markers such as coronary calcium scoring, IVUS, or OCT. Further research will be essential to determine whether reducing epicardial fat can slow or reverse plaque progression and translate into improved clinical outcomes.