{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T23:10:22Z","timestamp":1786317022471,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>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 \u00b1 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 \u2212190 to \u221230 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 = \u22120.26, p = 0.01), BMI (r = \u22120.40, p = 0.01), triglycerides (r = \u22120.44, p = 0.02), fasting glycemia (r = \u22120.49, p = 0.01), and total CVRF number (r = \u22120.40, 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.<\/jats:p>","DOI":"10.3390\/jcdd13060231","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:57:18Z","timestamp":1780070238000},"page":"231","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Volume and Density of Epicardial Adipose Tissue Measured by Computed Tomography as Markers of the Effects of Cardiovascular Disease Risk Factors"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8366-0239","authenticated-orcid":false,"given":"Pawe\u0142","family":"Ga\u0107","sequence":"first","affiliation":[{"name":"Centre for Diagnostic Imaging, 4th Military Hospital, 50-981 Wroclaw, Poland"},{"name":"Department of Environmental Health, Occupational Medicine and Epidemiology, Wroclaw Medical University, 50-345 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Przemys\u0142aw","family":"Che\u0142adze","sequence":"additional","affiliation":[{"name":"Centre for Diagnostic Imaging, 4th Military Hospital, 50-981 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"Por\u0119ba","sequence":"additional","affiliation":[{"name":"Centre for Diagnostic Imaging, 4th Military Hospital, 50-981 Wroclaw, Poland"},{"name":"Department of Biological Principles of Physical Activity, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: Update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S0140-6736(04)17018-9","article-title":"Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study","volume":"364","author":"Yusuf","year":"2004","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_4","first-page":"e984","article-title":"Obesity and cardiovascular disease: A scientific statement from the American Heart Association","volume":"143","author":"Poirier","year":"2021","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1038\/ncpcardio0319","article-title":"Epicardial adipose tissue: Anatomic, biomolecular and clinical relationships with the heart","volume":"2","author":"Iacobellis","year":"2005","journal-title":"Nat. Clin. Pract. Cardiovasc. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.tem.2011.07.003","article-title":"Epicardial adipose tissue: Emerging physiological, pathophysiological and clinical features","volume":"22","author":"Iacobellis","year":"2011","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Che\u0142adze, P., Martuszewski, A., Por\u0119ba, R., and Ga\u0107, P. (2022). The importance of the assessment of epicardial adipose tissue in scientific research. J. Clin. Med., 11.","DOI":"10.3390\/jcm11195621"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/j.acra.2011.03.011","article-title":"Quantification of epicardial adipose tissue: Correlation of surface area and volume measurements","volume":"18","author":"Saremi","year":"2011","journal-title":"Acad. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"328","DOI":"10.4070\/kcj.2010.40.7.328","article-title":"Assessment of epicardial fat volume with threshold-based 3-dimensional segmentation in CT: Comparison with the 2-dimensional short axis-based method","volume":"40","author":"Park","year":"2010","journal-title":"Korean Circ. J."},{"key":"ref_10","first-page":"e18","article-title":"Epicardial fat: Definition, measurements and systematic review of main outcomes","volume":"101","author":"Bertaso","year":"2013","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1093\/ehjci\/jes022","article-title":"The impact of epicardial fat volume on coronary plaque vulnerability: Insight from optical coherence tomography analysis","volume":"13","author":"Ito","year":"2012","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.atherosclerosis.2011.09.041","article-title":"Increased volume of epicardial fat is an independent risk factor for accelerated progression of sub-clinical coronary atherosclerosis","volume":"220","author":"Yerramasu","year":"2012","journal-title":"Atherosclerosis"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Krishnan, A., Sharma, H., Yuan, D., Trollope, A.F., and Chilton, L. (2022). The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9070217"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1038\/s41569-022-00679-9","article-title":"Epicardial adipose tissue in contemporary cardiology","volume":"19","author":"Iacobellis","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_15","first-page":"100734","article-title":"Epicardial adipose tissue in coronary microvascular disease","volume":"63","author":"Tran","year":"2026","journal-title":"Am. Heart J. Plus"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wu, Q., Guo, J., Liu, F., Dong, C., Wang, Y., Liu, L., and Zhang, S. (2025). Prognostic value of epicardial adipose tissue in heart failure: A systematic review and meta-analysis. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1618614"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Conte, M., Petraglia, L., Cabaro, S., Valerio, V., Poggio, P., Pilato, E., Attena, E., Russo, V., Ferro, A., and Formisano, P. (2022). Epicardial Adipose Tissue and Cardiac Arrhythmias: Focus on Atrial Fibrillation. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.932262"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"101188","DOI":"10.1016\/j.jacadv.2024.101188","article-title":"Artificial Intelligence Prediction of Cardiovascular Events Using Opportunistic Epicardial Adipose Tissue Assessments From Computed Tomography Calcium Score","volume":"3","author":"Hu","year":"2024","journal-title":"JACC Adv."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1139\/cjpp-2024-0384","article-title":"Epicardial adipose tissue as target of the incretin-based therapies in cardio-metabolic pathologies: A narrative review","volume":"103","author":"Pop","year":"2025","journal-title":"Can. J. Physiol. Pharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Picard, F.A., Gueret, P., Laissy, J.P., Champagne, S., Leclercq, F., Carrie, D., Juliard, J.-M., Henry, P., Niarra, R., and Chatellier, G. (2014). Epicardial adipose tissue thickness correlates with the presence and severity of angiographic coronary artery disease in stable patients with chest pain. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0110005"},{"key":"ref_21","first-page":"1294","article-title":"Epicardial fat and atrial fibrillation: Current evidence, potential mechanisms, clinical implications, and future directions","volume":"38","author":"Wong","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.jcmg.2014.07.002","article-title":"Association of epicardial adipose tissue with progression of coronary artery calcification is more pronounced in the presence of obesity: Results from the Heinz Nixdorf Recall Study","volume":"7","author":"Mahabadi","year":"2014","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jcct.2017.11.007","article-title":"Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation, and major adverse cardiac events in asymptomatic subjects","volume":"12","author":"Goeller","year":"2018","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Conte, M., Petraglia, L., Poggio, P., Valerio, V., Cabaro, S., Campana, P., Comentale, G., Attena, E., Russo, V., and Pilato, E. (2022). Inflammation and cardiovascular diseases in the elderly: The role of epicardial adipose tissue. Front. Med. Lausanne, 9.","DOI":"10.3389\/fmed.2022.844266"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.jacc.2013.06.027","article-title":"Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality","volume":"62","author":"Britton","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1016\/j.amjcard.2011.07.031","article-title":"Threshold for the upper normal limit of indexed epicardial fat volume: Derivation in a healthy population and validation in an outcome-based study","volume":"108","author":"Shmilovich","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1161\/CIRCULATIONAHA.117.029617","article-title":"Cardiovascular and metabolic heterogeneity of obesity: Clinical challenges and implications for management","volume":"137","author":"Neeland","year":"2018","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jcct.2016.01.009","article-title":"Epicardial adipose tissue volume but not density is an independent predictor for myocardial ischemia","volume":"10","author":"Hell","year":"2016","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1038\/ijo.2011.117","article-title":"Assessment of epicardial fat volume and myocardial triglyceride content in severely obese subjects: Relationship to metabolic profile, cardiac function and visceral fat","volume":"36","author":"Gaborit","year":"2012","journal-title":"Int. J. Obes. Lond."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1161\/CIRCULATIONAHA.107.743062","article-title":"Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample","volume":"117","author":"Rosito","year":"2008","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1016\/j.jacc.2012.12.051","article-title":"Effect of intensive versus moderate lipid-lowering therapy on epicardial adipose tissue in hyperlipidemic post-menopausal women: A substudy of the BELLES trial (Beyond Endorsed Lipid Lowering with EBT Scanning)","volume":"61","author":"Alexopoulos","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","first-page":"101325","article-title":"Epicardial adipose tissue volume and coronary calcification among people living with diabetes: A systematic review and meta-analysis","volume":"48","author":"Cosson","year":"2022","journal-title":"Diabetes Metab."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Che\u0142adze, P., Fu\u0142ek, M., Fu\u0142ek, K., Por\u0119ba, R., and Ga\u0107, P. (2025). Association between cardiovascular risk assessed by the SCORE system and cardiac computed tomography-derived left atrioventricular coupling index. Diagnostics, 15.","DOI":"10.3390\/diagnostics15091075"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Konwerski, M., G\u0105secka, A., Opolski, G., Grabowski, M., and Mazurek, T. (2022). Role of Epicardial Adipose Tissue in Cardiovascular Diseases: A Review. Biology, 11.","DOI":"10.3390\/biology11030355"},{"key":"ref_35","first-page":"e015159","article-title":"Epicardial Adipose Tissue Assessed by Computed Tomography and Echocardiography Are Associated With Adverse Cardiovascular Outcomes: A Systematic Review and Meta-Analysis","volume":"16","author":"Chong","year":"2023","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Mih\u0103il\u0103, M.D., Caloian, B., Fr\u00eengu, F.I., Irimie, D.A., Minciun\u0103, I.A., and Pop, D. (2025). Beyond Traditional Risk Factors: Integrating Epicardial Adipose Tissue into the Comorbidity Landscape of HFpEF. J. Clin. Med., 14.","DOI":"10.3390\/jcm14176139"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/6\/231\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:04:18Z","timestamp":1780635858000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/6\/231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":36,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcdd13060231"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13060231","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}