Perivascular Adipose Tissue and Atherosclerosis

  • Christos P. Kotanidis
  • Charalambos AntoniadesEmail author
Part of the Contemporary Cardiology book series (CONCARD)


Adipose tissue has long been identified as a key regulator of cardiovascular health, secreting a wealth of molecules, including hormones, cytokines, and gaseous messengers, which affect the cardiovascular system in both endocrine and paracrine manners. The diversity of adipose tissue biology has led to a shift in our perception of fat as an entity, highlighting the importance of regional variability. In that context, perivascular adipose tissue, a dynamic structure surrounding most vessels in the human body, and secreting a diverse range of adipocytokines and molecules, is being flagged as a distinct depot exerting crucial effects on the adjacent vascular wall and contributing to the development of atherosclerosis. At the same time, the vascular wall releases signaling molecules that diffuse into the perivascular space, modifying its texture and composition by forcing changes in perivascular fat biology. This bi-directional interplay between the vessels and perivascular fat has enabled significant translational advances, with pericoronary adipose tissue imaging emerging as a promising field in non-invasive visualization of atherosclerosis. This chapter summarizes the current knowledge on aspects of perivascular adipose tissue biology, its interplay with the vascular wall, as well as the diagnostic and prognostic value of its imaging, which aim to revolutionize cardiovascular risk prediction.


Perivascular adipose tissue Atherosclerosis Inflammation Computed tomography imaging Attenuation Radiomics 



CPK acknowledges support from the EPSRC, the Scatcherd Fund at the University of Oxford, and the A.G. Leventis Foundation.

CA is supported in part by the British Heart Foundation (FS/16/15/32047, TG/16/3/32687), the Oxford BHF Centre of Research Excellence, the Novo Nordisk Foundation (NNF15CC0018486), and Innovate UK.

Author Contributions

CPK performed the literature review, wrote the book chapter, and prepared the figures and table. CA provided scientific direction and wrote and reviewed the book chapter.

Conflict of Interest

The CaRi-HEART technology is subject to patent applications PCT/GB2015/052359, GB20161620494.3, GB20181818049.7, GR20180100490, and GR201801005100. CA is a founder and shareholder of Caristo Diagnostics, a CT-image analysis company.


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Christos P. Kotanidis
    • 1
  • Charalambos Antoniades
    • 1
    • 2
    Email author
  1. 1.Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
  2. 2.Oxford Academic Cardiovascular CT Core Laboratory, John Radcliffe Hospital, Headley WayOxfordUK

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