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Epicardial fat and vascular risk: a narrative review

Katsiki, Nikia; Mikhailidis, Dimitri P.b; Wierzbicki, Anthony S.c

Current Opinion in Cardiology: July 2013 - Volume 28 - Issue 4 - p 458–463
doi: 10.1097/HCO.0b013e3283605fba
LIPIDS AND HEART DISEASE: Edited by Anthony S. Wierzbicki and Dimitri P. Mikhailidis

Purpose of review We comment on the associations between epicardial adiposity and cardiovascular disease (CVD) and associated risk factors. The effects of lifestyle measures and CVD drugs on cardiac adipose tissue are also discussed.

Recent findings Epicardial adipose tissue exerts cardioprotective properties; however, in cases of pathological enlargement, epicardial fat can lead to myocardial inflammation and dysfunction as well as left ventricular hypertrophy and coronary artery disease (CAD) due to paracrine actions that include increased production of reactive oxygen species, atherogenic and inflammatory cytokines. Cardiac adiposity is associated with CAD, obesity, type 2 diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and chronic kidney disease, as well as with CVD risk factors such as lipids, hypertension, obesity markers, and carotid atherosclerosis.

Summary Due to its anatomical and functional proximity to the coronary circulation, epicardial adipose tissue may represent an even more direct CVD risk marker than central adiposity. Lifestyle measures and certain drugs may affect its thickness, although there are limited data currently available. The clinical implications of epicardial fat in daily practice remain to be established in future studies.

aSecond Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece

bDepartment of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL)

cDepartment of Metabolic Medicine/Chemical Pathology, St Thomas’ Hospital, London, UK

Correspondence to Dimitri P. Mikhailidis, BSc, MSc, MD, FRSPH, FCP, FFPM, FRCP, FRCPath, Academic Head, Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London, Pond Street, London NW3 2QG, UK. Tel: +44 0 20 7830 2258; fax: +44 0 20 7830 2235; e-mail: mikhailidis@aol.com

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins