Epicardial fat links obesity to cardiovascular diseases

Patients with obesity have been historically associated with higher risk to develop cardiovascular diseases (CVD). However, regional, visceral, organ specific adiposity seems to play a stronger role in the development of those cardiovascular diseases than obesity by itself. Epicardial adipose tissue is the visceral fat depot of the heart with peculiar anatomy, regional differences, genetic profile and functions. Due to its unobstructed contiguity with heart and intense pro inflammatory and pro arrhythmogenic activities, epicardial fat is directly involved in major obesity-related CVD complications, such as coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF). Current and developing imaging techniques can measure epicardial fat thickness, volume, den-sity and inflammatory status for the prediction and stratification of the cardiovascular risk in both symptomatic and asymptomatic obese individuals. Pharmacological modulation of the epicardial fat with glucagon like peptide-1 receptor (GLP1R) analogs, sodium glucose transporter-2 inhibitors, and potentially dual (glucose-dependent insulinotropic polypeptide -GLP1R) agonists, can reduce epicardial fat mass, resume its original cardio-protective functions and therefore reduce the cardiovascular risk. Epicardial fat assessment is poised to change the traditional paradigm that links obesity to the heart.& COPY; 2023 Elsevier Inc. All rights reserved.

Automated summary

Patients with obesity are at a higher risk of developing cardiovascular diseases. However, regional and organ specific adiposity appear to play a stronger role than obesity itself. Epicardial adipose tissue, located around the heart, is directly involved in major obesity-related cardiovascular complications. Current imaging techniques can assess epicardial fat to predict cardiovascular risk. Pharmacological modulation of epicardial fat can reduce cardiovascular risk. Assessing epicardial fat could change the traditional paradigm linking obesity to heart disease.