Epicardial Adipose Tissue in Cardiovascular Disease

Cardiovascular disease (CVD) is the main cause of morbidity and mortality in industrialized countries, despite the evolution of treatments and revascularization strategies. Obesity, also accompanied by a chronic inflammatory process, is an independent risk factor for CVD. Abdominal adipose tissue is a complex, metabolically very active organ capable of producing different adipokines and hormones, responsible for endocrine-metabolic comorbidities. The epicardial adipose tissue (EAT) has not been as extensively studied as the abdominal or subcutaneous adipose tissue. However, recent evidence associates it with an increased cardiometabolic risk due to its apposition with the heart. EAT stores triglycerides to provide energy to the myocardium and is characterized by its greater ability to release and capture free fatty acids. EAT strategic localization allows a singular cross talk with cardiomyocytes and vascular wall cells. The fact that EAT produces pro-inflammatory adipokines as well as metalloproteinases and pro-oxidant substances, highlights its possible direct impact on plaque vulnerability and heart failure, being still necessary further studies of EAT behavior in CVD.