Fat Around the Heart
Sarah Yoder Thomas, MD,
Romain Harmancey, PhD,
Heinrich Taegtmeyer, MD, DPhil*
We are intrigued by the report of Cheng et al. (1) on pericardial fat volume as a predictor of increased death and disability for cardiovascular disease. Although the investigators were not able to distinguish epicardial fat from pericardial fat and consequently omitted a discussion on the prognostic value of epicardial fat in predicting premature death and disability from cardiovascular disease, the data are of great interest. Threshold values of epicardial fat thickness (measured by echocardiography) were established previously, and increased epicardial fat mass was proposed as a predictor of cardiovascular disease by Iacobellis et al. (2). Furthermore, current knowledge of epicardial and pericardial fat suggests that these 2 tissues have different metabolic and physiologic properties (3–5). Given the difference in the metabolic function and anatomical locations of epicardial and pericardial fat, it may be reasonable to ask the following 2 questions. First, does pericardial fat increase the atherosclerotic burden because of the known immunomodulatory function of white adipose tissue (6,7)? Secondly, does epicardial fat increase the chances of heart failure because of its anatomical proximity to the myocardium? We have reasoned previously that epicardial fat delivers substrate directly to the heart and sets the stage for myocardial steatosis, akin to visceral fat setting the stage for hepatic steatosis (8). In short, there remain many unanswered questions regarding the fat around the heart, but with the help of modern technologies, the answers may be just around the corner.
* Department of Internal Medicine, Division of Cardiology, University of Texas Houston Medical School, 6431 Fannin, Room MSB 1.246, Houston, Texas 77030 (Email: heinrich.taegtmeyer{at}uth.tmc.edu).
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REFERENCES
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- Cheng VY, Dey D, Tamarappoo B, et al. Pericardial fat burden on ECG-gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events J Am Coll Cardiol Img 2010;3:352-360.[Abstract/Free Full Text]
- Iacobellis G, Willens HJ, Barbaro G, et al. Threshold values of high-risk echocardiographic epicardial fat thickness Obesity 2008;16:887-892.[CrossRef][Web of Science][Medline]
- Iacobellis G. Epicardial and pericardial fat: close, but very different Obesity 2009;17:625.[CrossRef][Web of Science][Medline]
- Rabkin SW. Epicardial fat: properties, function and relationship to obesity Obes Rev 2007;8:253-261.[CrossRef][Web of Science][Medline]
- Fain JN, Sacks HS, Bahouth SW, Tichansky DS, Madan AK, Cheema PS. Human epicardial adipokine messenger RNAs: comparisons of their expression in substernal, subcutaneous, and omental fat Metabolism 2010 Jan 29[E-pub ahead of print].
- Gregor FM, Hotamisligil GS. Adipocyte stress: the endoplasmic reticulum and metabolic disease J Lipid Res 2007;48:1905-1914.[Abstract/Free Full Text]
- Hotamisligil GS, Erbay E. Nutrient sensing and inflammation in metabolic disease Nat Rev Immunol 2008;8:923-934.[CrossRef][Web of Science][Medline]
- Harmancey R, Wilson CR, Taegtmeyer H. Adaptation and maladaptation of the heart in obesity Hypertension 2008;52:181-187.[Free Full Text]
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