Abstract
BACKGROUND: s: Epicardial adipose tissue (EAT) plays a crucial role in the development of coronary artery disease (CAD). This study aimed to evaluate the sex-specific relationship between EAT volume and CAD or its risk factors in an Indian cohort, filling the gap in data for the South Asian population. METHODS: The retrospective study included 950 subjects who underwent coronary computed tomography angiography (CCTA) from 2013 to 2016 at Sir Ganga Ram Hospital in India. The EAT volume and CAD status were examined. CAD risk factors such as age, body mass index (BMI), smoking, hypertension, diabetes, and cholesterol levels were documented. In a sex-specific fashion, the generalized additive model and multivariable logistic regression analyses were applied to assess the correlation between EAT volume and CAD or its risk factors. The two-piecewise linear regression model was applied to identify the inflection point for the nonlinear correlations. RESULTS: Results showed that EAT volume was larger in men than in women. A nonlinear relationship between EAT volume and CAD was identified in men but not in women, with an inflection point at 90 ml for men. The effect size of EAT volume on CAD was higher when EAT volume was below 90 ml. EAT volume was also linearly correlated with BMI in men. In the multivariable analysis, EAT volume was significantly associated with CAD and BMI in men, while no significant correlation was found in women. CONCLUSION: These findings suggest that EAT volume is an independent indicator of CAD risk in men, particularly in non-obese individuals. The sex-specific differences emphasize the importance of personalized approaches to CAD risk assessment in the South Asian population.