Adipose tissue: friend or foe?

The perception of adipose tissue has changed considerably with the dramatic increase in the incidence of obesity and obesity-related comorbidities over the past 3 decades. Excess fat is no longer associated with wealth, but is instead recognized as a risk factor for many diseases. Adipose tissue is increasingly being identified as a vital, complex endocrine organ, and not simply as a fat store. Not all fat is created equal-regional, developmental, structural, and functional variations exist. Epicardial adipose tissue is a metabolically active organ producing a number of factors that modulate cardiac structure and function. The global epidemic of obesity and metabolic syndrome imposes a major disease burden, particularly of cardiovascular disease. In this Review, we describe the various types of adipose tissue-their developmental biology, differentiation, cell heterogeneity, and functional characteristics. We discuss the link between adipose tissue and inflammation, the signaling factors released by adipose tissue, as well as cardiac adiposity and its relevance to cardiovascular diseases. Finally, we review the myocardial regenerative potential of adipose-tissue-derived stem cells. We believe that a thorough understanding of adipose tissue is of great clinical value.