BACKGROUND: Visceral adipose tissue (VAT) has been related to coronary artery disease (CAD), but its association with recurrent major adverse cardiovascular events (MACE) in premature CAD (pCAD) has not been fully explored. Thus, we aimed to investigate the impact of VAT on recurrent MACE in patients with pCAD. METHODS: This was a retrospective sub-analysis of 853 patients with pCAD from the GEA cohort study. VAT was measured by computed tomography at baseline. The primary outcome was the recurrence of MACE over 5 years of follow-up. Likewise, the association of VAT with non-fatal and fatal MACE was analyzed as a secondary outcome. Cox regression models were fitted and adjusted by confounders obtained at baseline to estimate adjusted hazard ratios (aHR). RESULTS: The median age of the patients was 53 years, and 80% were male, with a median follow-up of 4.9 years. Overall, 10% of the patients had recurrent MACE (6.5% non-fatal and 3.6% fatal) with an incidence rate of 18.5 (95% CI: 18.0-19.0) events per 1,000 person-years. VAT was positively associated with MACE. Those in the upper tertile (VAT ≥ 194 cm²) had the highest risk for total (aHR: 2.71
95% CI: 1.37-5.35
p=0.004) and non-fatal (aHR: 3.58
95% CI: 1.49-8.61
p=0.004) MACE. Fatal MACE was not statistically associated (aHR: 2.13
95% CI: 0.72-6.35
p=0.174). CONCLUSION: Among patients with pCAD, VAT increased the risk of recurrent MACE despite adequate pharmacological treatment. These results suggest that VAT could be considered an emergent risk factor and a promising target for residual cardiovascular risk reduction.