Local and systemic effects of the multifaceted epicardial adipose tissue depot
Abstract
Epicardial adipose tissue is a unique and multifaceted fat depot with local and systemic effects. This tissue is distinguished from other visceral fat depots by a number of anatomical and metabolic features, such as increased fatty acid metabolism and a unique transcriptome enriched in genes that are associated with inflammation and endothelial function. Epicardial fat and the heart share an unobstructed microcirculation, which suggests these tissues might interact. Under normal physiological conditions, epicardial fat has metabolic, thermogenic (similar to brown fat) and mechanical (cardioprotective) characteristics. Development of pathological conditions might drive the phenotype of epicardial fat such that it becomes harmful to the myocardium and the coronary arteries. The equilibrium between protective and detrimental effects of this tissue is fragile. Expression of the epicardial-fat-specific transcriptome is downregulated in the presence of severe and advanced coronary artery disease. Improved local vascularization, weight loss and targeted medications can restore the protective physiological functions of epicardial fat. Measurements of epicardial fat have several important applications in the clinical setting: accurate measurement of its thickness or volume is correlated with visceral adiposity, coronary artery disease, the metabolic syndrome, fatty liver disease and cardiac changes. On account of this simple clinical assessment, epicardial fat is a reliable marker of cardiovascular risk and an appealing surrogate for assessing the efficacy of drugs that modulate adipose tissues.
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EAT exerts mechanical protection of coronary arteries from excessive distortion and compression during contraction of neighbouring myocardium.
“Due to its spatial distribution, EAT exerts mechanical protection of coronary arteries from excessive distortion and compression during the contraction of neighbouring myocardium [29,30].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [30]
Cytokines may be released from epicardial tissue directly into vasa vasorum and transported downstream into the arterial wall by a vasocrine-signaling mechanism.
“There is even evidence for a microcirculatory connection between EAT and the coronary wall, by which cytokines may be released from epicardial tissue directly into vasa vasorum and transported downstream into the arterial wall by mean of a vasocrine-signaling mechanism [30].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [30]
EAT thickness by ultrasound correlates with waist circumference and intra-abdominal, intrahepatic, and intracardiac fat and serves as a good surrogate marker of visceral adiposity.
“However, EAT thickness by ultrasound has been shown to nicely correlate with waist circumference and intra-abdominal, intrahepatic, and intracardiac fat and serve as a good surrogate marker of visceral adiposity [1].”
From Effects of Semaglutide Versus Dulaglutide on Epicardial Fat Thickness in Subjects with Type 2 Diabetes and Obesity (2020) · cites this paper as [1]
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“EAT has unique embryolog ic and anatomic features, including smaller adipocytes , brown-fat like thermogenic and cardio-protective properties, greater fatty acid breakdown and higher inflammatory infiltrate when compared to subcutaneous adipose tissue (SAT) [1-8].”
BackgroundSalvatore, T., Galiero, R., Caturano, A., Vetrano, E., Rinaldi, L., Coviello, F., Di Martino, A., Albanese, G., Colantuoni, S., Medicamento, G., et al. (2022) · Biomolecules · doi:10.3390/biom12020176 · Cited by 62 · see citing works
- Authors
- Iacobellis, G.
- Affiliations
- University of Miami (US)
- Corresponding author
- Iacobellis, Gianluca
- ORCID
- Iacobellis, Gianluca
- Venue
- Nature Reviews Endocrinology
- Published
- 2015-04-07
- Volume
- 11
- Issue
- 6
- Pages
- 363-371
- ISSN
- 1759-5029 (ISSN-L)
- 1759-5037
- OpenAlex
- W2059087651
- Cited by
- 605
- References
- 108
- Citations by year
- 2026: 46 · 2025: 47 · 2024: 49 · 2023: 64 · 2022: 71 · 2021: 62 · 2020: 68 · 2019: 52 · 2018: 58 · 2017: 43 · 2016: 34 · 2015: 11
- FWCI
- 8.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Physiology › Adipose Tissue and Metabolism
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- epicardial adipose tissue, coronary artery disease, cardiometabolic disease, epicardial fat thickness, cardiovascular risk markers, fatty acid metabolism, thermogenesis, cardioprotection, inflammation, endothelial function, metabolic syndrome, hepatic steatosis, visceral fat
- MeSH terms
- Adipose Tissue, Cardiovascular Diseases, Coronary Artery Disease, Coronary Vessels, Fatty Liver, Humans, Inflammation, Microcirculation, Pericardium, Risk Factors, Metabolic Syndrome, Obesity, Abdominal, Transcriptome
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