***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: OBJECTIVES This study sought to determine whether epicardial fat volume predicts coronary events in the general population . BACKGROUND Epicardial adipose tissue ( EAT ) is suggested to promote plaque development in the coronary artery tree . METHODS We quantified EAT volume in participants from the prospect i ve population -based Heinz Nixdorf Recall cohort study free of cardiovascular disease .  Incident coronary events were assessed during a follow-up period of 8.0 ± 1.5 years . Multivariable association of EAT with cardiovascular risk factors , coronary artery calcification ( CAC ) , and coronary events was assessed using regression analysis . RESULTS From the overall 4,093 participants ( age 59.4 years , 47 % male ) , 130 subjects developed a fatal or nonfatal coronary event . Incidence of coronary events increased by quartile of EAT ( 0.9 % vs. 4.7 % for 1(st ) and 4th quartile , respectively , p < 0.001 ) . Doubling of EAT was associated with a 1.5-fold risk of coronary events when adjusting for cardiovascular risk factors ( hazard ratio [ HR ] [ 95 % confidence interval ( CI ) ] : 1.54 [ 1.09 to 2.19 ] ) , which remained unaltered after further adjustment for CAC score ( HR [ 95 % CI ] : 1.50 [ 1.07 to 2.11 ] ) . For discrimination of subjects with events from those without , we observed a trend for improvement of Harrell 's C and explained variance by EAT over traditional cardiovascular risk factors , which , however , did not reach statistical significance ( 0.720 to 0.730 for risk factors alone and with EAT added , respectively , p = 0.10 , R(2 ) = 2.73 % to R(2 ) = 2.92 % , time-dependent integrated discrimination improvement = 0.196 % ) . CONCLUSIONS Epicardial fat is associated with fatal and nonfatal coronary events in the general population independent of traditional cardiovascular risk factors and complements information from cardiac computed tomography above the CAC score OBJECTIVES The aim of this study was to determine whether ectopic fat depots are prospect ively associated with  cardiovascular disease , cancer , and all-cause mortality .  BACKGROUND The morbidity associated with excess body weight varies among individuals of similar body mass index . Ectopic fat depots may underlie this risk differential . However , prospect i ve studies of directly measured fat are limited . METHODS Participants from the Framingham Heart Study ( n = 3,086 ; 49 % women ; mean age of 50.2 years ) underwent assessment of fat depots ( visceral adipose tissue , pericardial adipose tissue , and periaortic adipose tissue ) using multidetector computed tomography and were followed up longitudinally for a median of 5.0 years . Cox proportional hazards regression models were used to examine the association of each fat depot ( per 1 SD increment ) with the risk of incident cardiovascular disease , cancer , and all-cause mortality after adjustment for st and ard risk factors , including body mass index . RESULTS Overall , there were 90 cardiovascular events , 141 cancer events , and 71 deaths . After multivariable adjustment , visceral adipose tissue was associated with cardiovascular disease ( hazard ratio : 1.44 ; 95 % confidence interval : 1.08 to 1.92 ; p = 0.01 ) and cancer ( hazard ratio : 1.43 ; 95 % confidence interval : 1.12 to 1.84 ; p = 0.005 ) . Addition of visceral adipose tissue to a multivariable model that included body mass index modestly improved cardiovascular risk prediction ( net reclassification improvement of 16.3 % ) . None of the fat depots were associated with all-cause mortality . CONCLUSIONS Visceral adiposity is associated with incident cardiovascular disease and cancer after adjustment for clinical risk factors and generalized adiposity . These findings support the growing appreciation of a pathogenic role of ectopic fat Background —Noncontrast cardiac computed tomography allows calculation of coronary artery calcium score ( CACS ) and measurement of epicardial adipose tissue ( EATv ) and intrathoracic fat ( ITFv ) volumes . It is unclear whether fat volume information contributes to risk stratification . Methods and Results —Cardiac computed tomography was performed in 760 consecutive patients with acute chest pain admitted thorough the emergency department . None had prior coronary artery disease . CACS was calculated using the Agatston method . EATv and ITFv were semiautomatically calculated . Median patient follow-up was 3.3 years . Mean patient age was 54.4±13.7 years and Framingham risk score 8.2±8.2 . The 45 patients ( 5.9 % ) with major acute cardiac events ( MACE ) were older ( 64.8±13.9 versus 53.7±13.4 years ) , more frequently male ( 60 % versus 40 % ) , and had a higher median Framingham risk score ( 16 versus 4 ) and CACS ( 268 versus 0 ) versus those without events ( all P<0.01 ) . The MACE group had a higher median of EATv ( 154 versus 116 mL ) and ITFv ( 330 versus 223 mL ) , and a higher prevalence of EATv > 125 mL ( 67 % versus 44 % ) and ITFv > 250 mL ( 64 % versus 42 % ) ( all P<0.01 ) . CACS , EATv , and ITFv were all independently associated with MACE . CACS was associated with MACE after adjustment for fat volumes ( P<0.0001 ) , whereas EATv and ITFv improved the risk model only in patients with CACS > 400 . Conclusions —CACS and fat volumes are independently associated with MACE in acute chest pain patients and beyond that provided by clinical information alone . Although fat volumes may add prognostic value in patients with CACS > 400 , CACS is most strongly correlated with outcome BACKGROUND Epicardial adipose tissue ( EAT ) has been described in the general population as an independent risk marker for incident coronary artery disease .  In hemodialysis patients , it correlates with other markers of cardiovascular disease , but it is unknown if it is associated with adverse events . METHODS post hoc analysis of the Renagel in New Dialysis ( RIND ) patients study , a r and omized trial of sevelamer versus calcium-based phosphate binders in 109 incident hemodialysis patients , followed for all-cause mortality for a median of 49.3 months . Patients underwent baseline cardiac computed tomography imaging within 120 days of dialysis initiation . RESULTS Baseline EAT measurements were available in 95 patients ; EAT was positively correlated with age , body mass index , triglycerides , C-reactive protein , coronary artery calcium and aortic calcium , and negatively correlated with systolic and diastolic blood pressure , serum high density lipoprotein ( HPL ) cholesterol and serum phosphate ( all P < 0.05 ) . During follow-up , a total of 27 ( 28.4 % ) patients expired [ mortality per 1000 patients /year : 95 % confidence interval ( 95 % CI ) = 77 ( 64 - 94 ) ] . Five-year survival rate was 44 . 6 % ( 95 % CI : 21.1 - 65.7 ) and 71.2 % ( 95 % CI : 45.95 - 86.25 ) in patients with EAT above or below the median , respectively . Each 10 cc increase in EAT volume was associated with a significant 6 % increase in the risk of death during follow-up [ hazard ratio ( HR ) : 1.060 ; 95 % CI : 1.013 - 1.109 ; P-value = 0.012 ] . CONCLUSIONS In this sub analysis of a r and omized trial , EAT was an independent predictor of mortality in incident hemodialysis patients after ~4 years of follow-up . These hypothesis-generating findings will need confirmatory evidence BACKGROUND Coronary artery disease ( CAD ) diagnosis by coronary computed tomographic angiography ( CCTA ) is useful for identification of symptomatic diabetic individuals at heightened risk for death . Whether CCTA-detected CAD enables improved risk assessment of asymptomatic diabetic individuals beyond clinical risk factors and coronary artery calcium scoring ( CACS ) remains unexplored . METHODS From a prospect i ve 12-center international registry of 27,125 individuals undergoing CCTA , we identified 400 asymptomatic diabetic individuals without known CAD . Coronary stenosis by CCTA was grade d as 0 % , 1 - 49 % , 50 - 69 % , and ≥70 % . CAD was judged on a per-patient , per-vessel and per-segment basis as maximal stenosis severity , number of vessels with ≥50 % stenosis , and coronary segments weighted for stenosis severity ( segment stenosis score ) , respectively . We assessed major adverse cardiovascular events ( MACE ) - inclusive of mortality , nonfatal myocardial infa rct ion ( MI ) , and late target vessel revascularization ≥90 days ( REV ) - and evaluated the incremental utility of CCTA for risk prediction , discrimination and reclassification . RESULTS Mean age was 60.4 ± 9.9 years ; 65.0 % were male . At a mean follow-up 2.4 ± 1.1 years , 33 MACE occurred ( 13 deaths , 8 MI , 12 REV ) [ 8.25 % ; annualized rate 3.4 % ] . By univariate analysis , per-patient maximal stenosis [ hazards ratio ( HR ) 2.24 per stenosis grade , 95 % confidence interval ( CI ) 1.61 - 3.10 , p < 0.001 ] , increasing numbers of obstructive vessels ( HR 2.30 per vessel , 95 % CI 1.75 - 3.03 , p < 0.001 ) and segment stenosis score ( HR 1.14 per segment , 95 % CI 1.09 - 1.19 , p < 0.001 ) were associated with increased MACE . After adjustment for CAD risk factors and CACS , maximal stenosis ( HR 1.80 per grade , 95 % CI 1.18 - 2.75 , p = 0.006 ) , number of obstructive vessels ( HR 1.85 per vessel , 95 % CI 1.29 - 2.65 , p < 0.001 ) and segment stenosis score ( HR 1.11 per segment , 95 % CI 1.05 - 1.18 , p < 0.001 ) were associated with increased risk of MACE . Beyond age , gender and CACS ( C-index 0.64 ) , CCTA improved discrimination by maximal stenosis , number of obstructive vessels and segment stenosis score ( C-index 0.77 , 0.77 and 0.78 , respectively ) . Similarly , CCTA findings improved risk reclassification by per-patient maximal stenosis [ integrated discrimination improvement ( IDI ) index 0.03 , p = 0.03 ] and number of obstructive vessels ( IDI index 0.06 , p = 0.002 ) , and by trend for segment stenosis score ( IDI 0.03 , p = 0.06 ) . CONCLUSION For asymptomatic diabetic individuals , CCTA measures of CAD severity confer incremental risk prediction , discrimination and reclassification on a per-patient , per-vessel and per-segment basis BACKGROUND Pericardial fat ( ie , fat around the heart ) may have a direct role in the atherosclerotic process in coronary arteries through local release of inflammation-related cytokines . Cross-sectional studies suggest that pericardial fat is positively associated with coronary artery disease independent of total body fat . OBJECTIVE We investigated whether pericardial fat predicts future coronary heart disease events . DESIGN We conducted a case-cohort study in 998 individuals , who were r and omly selected from 6814 Multi-Ethnic Study of Atherosclerosis ( MESA ) participants and 147 MESA participants ( 26 from those 998 individuals ) who developed incident coronary heart disease from 2000 to 2005 . The volume of  pericardial fat  was determined from cardiac computed tomography at baseline . RESULTS The age range of the subjects was 45 - 84 y ( 42 % men , 45 % white , 10 % Asian American , 22 % African American , and 23 % Hispanic ) . Pericardial fat was positively correlated with both body mass index ( correlation coefficient = 0.45 , P < 0.0001 ) and waist circumference ( correlation coefficient = 0.57 , P < 0.0001 ) . In unadjusted analyses , pericardial fat ( relative hazard per 1-SD increment : 1.33 ; 95 % CI : 1.15 , 1.54 ) , but not body mass index ( 1.0 
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Conclusions The majority of studies suggest that EFV quantification is significantly associated with clinical outcomes and provides incremental prognostic value over coronary artery calcium scoring .
Future research should use a binary cutoff of 125 mL for evaluation of EFV to provide consistency with other research .Key Points• Epicardial fat volume ( EFV ) has prognostic value for adverse cardiac events • Establishment of st and ardized quantitative categories for EFV is needed • Quantification of EFV could improve risk assessment with calcium