Can Lipid Tissues Including Epicardial Adipose Tissue (EAT), Visceral Adipose Tissue (VAT) and Coronary Plaque Be Moving in the Same Direction?

In contrast to the patients with significant coronary atherosclerosis, the current guidelines do not recommend using CCTA for asymptomatic subjects to evaluate their degree of CAD. Choi and colleagues evaluated 1,000 asymptomatic subjects who underwent CCTA as a general health evaluation and in 215 (22%) patients, atherosclerotic plaques were identified and of them only 52 (5%) subjects had stenosis greater than 50%.6 Although CCTA is able to detect coronary artery stenosis noninvasively, one of its major limitations as a screening method is the extremely low prevalence of CAD in asymptomatic patients. As we also have to consider contrast media, radiation exposure, and cost effectiveness, CCTA is not recommended as a screening tool. t has been well established that coronary computed tomography angiography (CCTA) is useful for evaluating significant obstructive coronary artery disease (CAD), associated with sensitivity, specificity, positive and negative predictive values of 88, 96, 79, and 98%, respectively.1 CCTA can precisely visualize coronary plaques and subsequently evaluate the risk of cardiac events in addition to invasive coronary angiography.2 Although the CT characteristics of plaques associated with acute coronary syndrome (ACS) include positive vascular remodeling, low plaque density and spotty calcification,3 patients demonstrating positively remodeled coronary segments with low-attenuation plaques on CCTA are at a higher risk of ACS developing over time in comparison with patients having lesions without these characteristics4 (Figure 1). Furthermore, meta-analyses of 18 studies comprising 9,592 patients also confirm that the risk of adverse cardiac events is significantly associated with the extent and severity I