Epicardial adipose tissue and progression of coronary artery calcium: cause and effect or simple association?

I n this issue of iJACC, Mahabadi et al. (1) describe a parallel increase of subclinical atherosclerosis and epicardial adipose tissue (EAT). Two prior publications (2,3) reported a similar association, and together with experimental models, they support the role of EAT in atherosclerosis inception and progression. In an experimental porcine model, the investigators stripped the epicardial fat covering the middle section of the left anterior descending coronary artery and kept the animals alive for 3 more months on an atherosclerotic diet (4). They also performed intravascular ultrasound imaging before EAT stripping and just before sacrificing the