PAT was evaluated using cardiac computed tomography in accordance with a protocol described by McClain et al. (2 (link)). In summary, the left main coronary artery superior extent was distinguished in a cross-sectional scan; slices within 15 mm above and 30 mm below this slice were included. The anterior border was identified by the chest wall and the posterior border by the aorta and the bronchus. Volume Analysis software (GE Healthcare, Waukesha, WI) was used to discern fat from the remaining portions of the heart with a threshold of −190 to −30 Hounsfield units. The volume was the sum of all voxels containing pericardial adipose tissue. Baseline PAT was used in the cross-sectional analysis and measurements from follow-up exams 2, 3 and 4 were used tabulate rate of change from baseline (cm3/year) with a median follow-up time of 3-years.