Epicardial fat, which directly surrounds major epicardial coronary arteries, is known to be a rich source of free fatty acids and numbers of bioactive adipocytokines that plays important role in the development of atherosclerosis.

Multi-detector computed tomography (MDCT) allows simultaneous assessment of coronary artery calcium, coronary artery stenosis, coronary plaque characteristics, and also epicardial fat volume (EFV), without increased radiation exposure nor additional cost.

Although several studies using MDCT have shown a relationship between EFV and coronary artery calcium, it is unknown whether elevated EFV indicates the possibility of greater plaque progression over time, and whether increase in EFV is accompanied by a parallel increase in coronary plaque volume.

We explored whether the baseline indexed epicardial fat volume (EFVi) and the serial change in EFVi were associated with the progression of coronary calcium score assessed by multi-detector computed tomography (MDCT).