The Volume and Density of Epicardial Adipose Tissue Measured by Computed Tomography as Markers of the Effects of Cardiovascular Disease Risk Factors

Background/Objectives: Epicardial adipose tissue (EAT), a visceral fat depot located between the myocardium and the visceral pericardium, has emerged as a potential imaging biomarker of cardiometabolic dysfunction and cardiovascular health. This study aimed to evaluate whether computed tomography (CT)-derived epicardial adipose tissue volume (EATV) and epicardial adipose tissue density (EATD) may serve as markers of the effects of major cardiovascular disease risk factors. Methods: This cross-sectional study included 105 participants (mean age: 62.12 ± 11.20 years; 58.1% women) examined with coronary computed tomography angiography. Clinical evaluation included anthropometric assessment, blood pressure measurement, laboratory testing, and questionnaire-based smoking status. EAT was assessed using semi-automatic segmentation on a dedicated post-processing workstation, with visual verification and manual correction, when necessary, within an attenuation range of −190 to −30 HU. Two parameters were analyzed: EATV and EATD. Results: EATV was significantly higher in men, participants with overweight/obesity, participants with dyslipidemia, and participants with type 2 diabetes. EATD was significantly lower in participants with overweight/obesity, dyslipidemia, and type 2 diabetes. Both EATV and EATD were associated with the total number of CVRFs. Correlation analysis showed that EATV was positively associated with age (r = 0.20, p = 0.04), BMI (r = 0.54, p = 0.01), fasting glycemia (r = 0.46, p = 0.01), and total CVRF number (r = 0.51, p = 0.01), whereas EATD was negatively associated with age (r = −0.26, p = 0.01), BMI (r = −0.40, p = 0.01), triglycerides (r = −0.44, p = 0.02), fasting glycemia (r = −0.49, p = 0.01), and total CVRF number (r = −0.40, p = 0.01). In regression analysis, older age, higher BMI, male gender, and dyslipidemia were independent risk factors for higher EATV, while dyslipidemia and type 2 diabetes were independent risk factors for lower EATD. Conclusions: Greater exposure to major cardiovascular disease risk factors was associated with higher EAT volume and lower EAT density, supporting the role of EAT as a structural and metabolic marker of the effects of cardiovascular disease risk factors on cardiovascular health.