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Under cardiometabolic stress, it undergoes phenotypic remodeling toward a pro-inflammatory state, promoting endothelial dysfunction, atherosclerotic progression, and plaque vulnerability through bidirectional signaling with the vessel wall. Advances in coronary computed tomography angiography allow non-invasive quantification of PCAT attenuation, which reflects subclinical coronary inflammation and is associated with high-risk plaque features and adverse cardiovascular outcomes. PCAT attenuation and the fat attenuation index appear responsive to lipid-lowering and anti-inflammatory therapies. Altogether, these insights underscore PCAT as a promising link between coronary inflammation and atherosclerotic risk, potentially reshaping future approaches to CAD detection, risk stratification, and intervention.<\/jats:p>","DOI":"10.1177\/00033197261484342","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T08:52:31Z","timestamp":1789980751000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pericoronary Adipose Tissue in Coronary Artery Disease: Integrating Molecular Mechanisms, Imaging Biomarkers, and Therapeutic Insights"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8278-6994","authenticated-orcid":false,"given":"Kevin","family":"Thomas Mathew","sequence":"first","affiliation":[{"name":"Research Department, INSCRIBE by INCREDOC, Tbilisi, Georgia"},{"name":"Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5124-5848","authenticated-orcid":false,"given":"Biriyankan","family":"Balakumar","sequence":"additional","affiliation":[{"name":"Research Department, INSCRIBE by INCREDOC, Tbilisi, Georgia"},{"name":"Department of Medicine, New Vision University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7443-7148","authenticated-orcid":false,"given":"Iqrah","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Research Department, INSCRIBE by INCREDOC, Tbilisi, Georgia"},{"name":"Department of Medicine, New Vision University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6132-4092","authenticated-orcid":false,"given":"Damini","family":"Haridas","sequence":"additional","affiliation":[{"name":"Research Department, INSCRIBE by INCREDOC, Tbilisi, Georgia"},{"name":"Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0054-7877","authenticated-orcid":false,"given":"Annet Yesudas","family":"Darshi","sequence":"additional","affiliation":[{"name":"Research Department, INSCRIBE by INCREDOC, Tbilisi, Georgia"},{"name":"Department of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7887-5785","authenticated-orcid":false,"given":"Kylie","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Research Department, INSCRIBE by INCREDOC, Tbilisi, Georgia"},{"name":"Department of Medicine, Tbilisi State Medical University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9704-8936","authenticated-orcid":false,"given":"Atka","family":"Haq","sequence":"additional","affiliation":[{"name":"Research Department, INSCRIBE by INCREDOC, Tbilisi, Georgia"},{"name":"Department of Medicine, New Vision University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5841-8073","authenticated-orcid":false,"given":"Noor","family":"Darwish","sequence":"additional","affiliation":[{"name":"Research Department, INSCRIBE by INCREDOC, Tbilisi, Georgia"},{"name":"Department of Medicine, European University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22083850"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejphar.2024.176338"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.21037\/qims-24-1245"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12237212"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/20584601251342312"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1451807"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaa224"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaf062"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00055-8"},{"issue":"7","key":"e_1_3_2_11_2","first-page":"3148","article-title":"An integrated approach to coronary heart disease diagnosis and clinical management","volume":"9","author":"Infante T","year":"2017","unstructured":"Infante T, Forte E, Schiano llah C, et al. 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