Epicardial adipose tissue signatures in Asian coronary artery disease: Insights from cardiac CT

Objectives: We aim to compare cardiac CT characteristics of epicardial adipose tissue (EAT), coronary plaque, and perivascular adipose tissue (PVAT) among East, South and Southeast Asian coronary artery disease (CAD) patients. Methods: This retrospective, cross-sectional study analyzed data from 2702 stable CAD patients, including 2078 East (56.4 ± 11.2 years, 59.5% male), 310 South (53.2 ± 10.4 years, 62.4% male), and 314 Southeast Asian (52.9 ± 11.2 years, 60.6% male) patients. From this clinical cohort, available imaging subsets were analyzed: 1090 patients with analyzable non-contrast computed tomography for EAT assessment and 751 patients with coronary computed tomography angiography for plaque and PVAT characterization. Results: > 0.05). Despite higher diabetes prevalence and family history of CAD in South Asian patients, these factors were not independently associated with EAT differences. Conclusions: In a multi-ethnic Asian cohort of stable CAD patients, South Asians showed a distinct pro-inflammatory EAT profile, including higher EAT attenuation and high-density volume ratio, independent of traditional risk factors, despite having similar coronary plaque burden, composition, and PVAT characteristics as other Asian groups. This finding suggests that ethnic-specific cardiovascular pathophysiology may operate through mechanisms beyond traditional cardiovascular risk factors.