Epicardial fat: a novel marker of subclinical atherosclerosis in clinical practice?

In this issue of Anatolian Journal of Cardiology published on article “An increased epicardial adipose tissue is strongly associated with Carotid Intima-Media Thickness and the atherosclerotic plaque, but LDL only with the plaque,” by Kocaman et al. (1) evaluated the association between epicardial adipose tissue (EAT) and markers of subclinical carotid atherosclerosis in 252 obese patients with hypertension, diabetes and/or dyslipidemia, attending the outpatient clinic. Patients with symptoms suggestive of coronary heart disease confirmed by relevant findings on exercise electrocardiogram and perfusion scan were excluded. The authors demonstrated that EAT was strongly and independently associated with both carotid intima-media thickness (CIMT) and the presence of carotid plaques (1). In contrast, among traditional cardiovascular (CV) risk factors, age and male gender correlated only with CIMT, whereas low-density lipoprotein cholesterol (LDLC) was related only to the presence of carotid plaques. Of note, CIMT increased with increasing LDL-C levels only in patients with EAT >5 mm. These findings highlight the potential clinical use of EAT in assessing subclinical atherosclerosis