Sex-specific prognostic value of automated epicardial adipose tissue quantification on serial lung cancer screening chest computed tomography
Authors' conclusion
In this large lung cancer screening cohort, serial EAT changes independently predicted CV mortality in women and were more strongly associated with all-cause mortality in women than in men.
Study context
- Population
- Heavy-smoking participants of the National Lung Screening Trial with serial low-dose chest computed tomography (CT)
- Participants
- 24,008 participants
- Comparison
- Women vs men: prognostic value of baseline and 2-year change in epicardial adipose tissue (EAT)
- Womenn = 9,841
- Primary endpoint
- All-cause and CV mortality
- Follow-up
- Median 12.3 years (IQR: 11.9-12.8)
Methodological detailsprognostic cohort study, sex-stratified multivariable Cox models, automated deep-learning EAT quantification, serial low-dose chest CT
- Prognostic cohort study
- Sex-stratified multivariable Cox models
- Automated deep-learning EAT quantification
- Serial low-dose chest CT
Primary result
As reported in the abstract
All-cause and CV mortality by baseline EAT and 2-year EAT change, by sex
Adjusted hazard ratio (95% CI)P value
Womenvs Menbaseline EAT, max. aHR; P-interaction = 0.986
1.70(1.13–2.55)
Menbaseline EAT, max. aHR; P-interaction = 0.986
1.83(1.40–2.40)
Womenvs Men2-year EAT change, CV death; predicted CV death only in women
1.82(1.37–2.49)
P < 0.001Womenvs Men2-year EAT change, all-cause mortality; P-interaction = 0.041
1.52(1.31–1.77)
Men2-year EAT change, all-cause mortality; P-interaction = 0.041
1.26(1.13–1.40)
- All-cause deaths
- 4668 (19.4%)
- Cardiovascular (CV) deaths
- 1083 (4.5%)
Further findings
Baseline characteristics, women vs men
- Women younger, with fewer CV risk factors, lower body mass index (BMI), fewer pack-years and lower coronary artery calcium (CAC) than men
- all P < 0.001
Original publication
Sex-specific prognostic value of automated epicardial adipose tissue quantification on serial lung cancer screening chest computed tomography. Eur Heart J Cardiovasc Imaging. Published 29 August 2025. doi:10.
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