Hindsight: Epicardial Fat and Cardiovascular Risk

Dr. Gianluca Iacobellis

Dr. Gianluca Iacobellis

In 2005 I was joined by Gianluca Iacobellis at McMaster, with whom I published a paper in Nature Clinical Practice: Cardiovascular Medicine on the anatomic, biomolecular and clinical role of epicardial fat.

In this paper we reviewed the growing evidence that epicardial fat is a metabolically active organ that generates various bioactive molecules, which could well affect cardiac function.

We speculated that, although relatively small, this ‘visceral’ fat depot is a rich source of free fatty acids and a number of bioactive molecules, such as adiponectin, resistin and inflammatory cytokines, which could affect the coronary artery response.

We also noted that epicardial fat mass might reflect intra-abdominal visceral fat and proposed that echocardiographic assessment of this tissue could serve as a reliable marker of visceral adiposity.

Furthermore, epicardial adipose tissue is clinically related to left ventricular mass and other features of the metabolic syndrome, such as concentrations of LDL cholesterol, fasting insulin and adiponectin, and arterial blood pressure.

Thus, we suggested that echocardiographic assessment of epicardial fat could serve as a simple and practical tool for cardiovascular risk stratification in clinical practice and research.

While assessment of epicardial fat is not yet part of routine clinical assessment, since we published this paper, interest in this tissue has grown substantially and new research on the function of this tissue are now a recurring topic of interest at cardiovascular conferences around the world.

Edmonton, Alberta