Regional fat distribution as a predictor of carotid atherosclerosis: insights from mediastinal and cervical fat analysis

Objective Atherosclerosis is a leading cause of cardiovascular diseases such as myocardial infarction and stroke. Obesity, particularly regional fat distribution, is known to play a significant role in the pathogenesis of atherosclerosis. The aim of our study is to investigate the relationship between the anterior mediastinal fat tissue area, posterior cervical subcutaneous fat tissue thickness, and the presence of carotid plaque. Methods This retrospective study included 273 patients who underwent carotid CT angiography between 2021 and 2023. Patients under 18 years, with malignancy, or with inadequate image quality were excluded. Anterior mediastinal fat tissue area was measured manually on axial CT images, and posterior cervical subcutaneous fat thickness was measured on sagittal images. Statistical analyses included the Mann-Whitney U test, Spearman's correlation, and logistic regression. Results There was a significant positive correlation between mediastinal fat area and carotid plaque presence (rs = 0.3417, p < 0.05). The optimal cut-off value for mediastinal fat area to detect carotid plaque was 575 mm², with 78.79% sensitivity and 62.67% specificity. No significant correlation was found between cervical fat thickness and carotid plaque presence. Conclusion The anterior mediastinal fat tissue area is a moderate predictor of carotid plaque presence and can be easily measured during routine CT scans. This measurement may help identify patients at risk of atherosclerosis and guide further diagnostic evaluations.