# Epicardial adipose tissue volume outperforms density in association with cardiorenal complications in hypertensive patients

## TL;DR

This study finds that the amount of heart fat is more strongly linked to heart and kidney issues in people with high blood pressure than the fat's density.

## Contribution

The study demonstrates that EAT volume is a better predictor of cardiorenal complications in hypertensive patients than EAT density.

## Key findings

- Hypertensive patients had significantly higher EAT volume than non-hypertensive individuals.
- EAT volume was strongly correlated with multiple cardiorenal complications indicators.
- EAT volume mediated a significant portion of the relationship between hypertension and cardiac complications.

## Abstract

Epicardial adipose tissue (EAT) dysfunction is closely related to a variety of cardiovascular diseases. However, controversy persists regarding the association between EAT characteristics and hypertension (HTN). The present study aims to clarify the changes of EAT volume and density in HTN patients, and explore their relationships with cardiorenal complications.

A total of 257 individuals were enrolled in this study for analysis, including 156 HTN patients and 101 non-HTN participants. EAT volume and density were measured using coronary computerized tomography angiography (CCTA). Cardiorenal complications were evaluated by laboratory indicators, echocardiography, and CCTA. Correlation analysis was used to examine the relationship between EAT characteristics and various cardiorenal complications. Mediation analysis was performed to test whether EAT characteristics played mediating effects between HTN and cardiorenal complications.

Compared to non-HTN participants, HTN patients exhibited a markedly higher volume of EAT (154.40 ± 53.31 vs. 132.49 ± 45.88 cm3, P < 0.001). Nevertheless, there was no significant difference in density between the two groups (-80.22 ± 6.84 vs. -79.25 ± 7.16 HU, P = 0.279). Correlation analyses showed that the volume of EAT was strongly correlated with most indicators of cardiorenal complications (all P < 0.05), including severity of coronary artery disease (plaque volume, CACS, and CT-FFR), abnormal cardiac structure and function (aorta, LA, IVS, LVPW, LVEF, E/A ratio, and NT-proBNP), and renal dysfunction (BUN, serum creatinine, CysC, and eGFR), while the density of EAT was only correlated with partial indicators of cardiorenal complications. Mediation analysis found that EAT volume had significant mediating effects between HTN and cardiac complications (mediation proportions: 68.30% for plaque volume, 40.67% for CACS, 13.51% for CT-FFR, 10.63% for aorta, and 12.78% for IVS, respectively).

EAT volume, rather than density, is significantly increased in HTN patients and closely associated with cardiorenal complications. This finding provides a new perspective for preventing HTN complications by targeting the reduction of heart-specific visceral adipose tissue.

The online version contains supplementary material available at 10.1186/s12944-026-02873-x.