Increased epicardial adipose tissue is associated with coronary artery disease and major adverse cardiovascular events. 
Increased-epicardial-adipose tissue (EAT) is associated with the presence and severity of subclinical-atherosclerosis.  This study investigates the long-term clinical-outcome of subjects with and without increased-EAT.  Two hundred and forty-five subjects, aged 61 ± 9 years and 34% women underwent clinically-indicated computed-tomography-angiography (CTA), and body-surface-area adjusted EAT was measured and were followed prospectively.  CTA-diagnosed coronary-artery-disease (CAD) was defined as obstructive (luminal-stenosis ≥ 50%), non-obstructive (luminal-stenosis: 1-49%) and zero-obstruction.  Major-adverse-cardiac-event (MACE) was defined as myocardial-infarction or cardiovascular-death.  EAT increased significantly from subjects with zero-obstruction-coronaries (93 ± 37 cm(3)/m(2)) to non-obstructive-CAD (132 ± 25 cm(3)/m(2)) to obstructive-CAD (145 ± 35 cm(3)/m(2)) (P = 0.01).  During the 48-month follow-up, the event-rate was 8.6% (21).  The event free survival-rate decreased significantly from 99% in the lowest-quartile to 86.6% in the highest-quartile of EAT.  After adjustment for risk-factors, the hazard ratio of MACE was 1.4, 3.1 and 5.7 in lower mid-, upper mid- and highest-quartiles of EAT as compared to lowest-quartile of EAT (P < 0.05).  Increased EAT is directly associated with CAD and predicts MACE independent of the age, gender and conventional-risk-factors.