We all know by now that too much body fat isn’t good for your heart, and new research suggests that the fat directly around your heart could play a role in your risk of coronary artery disease (CAD).
- Fat around the heart is also known as epicardial adipose tissue (EAT).
- While studies have looked at overall body fat burden as a clinical risk factor, none have tried to quantify the risk of a fatty heart until the PARADIGM registry.
Drawing data from PARADIGM, researchers followed 773 patients for eight years after they underwent serial CCTA imaging and categorized them into three EAT volume categories: low (≤ 77 cm3), moderate (77-113 cm3), and high (> 113 cm3).
- Nearly all patients (83.7%) saw their plaque volume progress, while a third of them developed new plaque after starting a zero.
- Progression of total plaque volume (including calcified and non-calcified) was consistently greater for the highest EAT volume category.
- Additionally, plaque progression rates (78.9% vs. 83.9% vs. 88.5%) increased across all three EAT categories.
There’s a serious caveat to these results though, since researchers determined that EAT volume measured with CCTA was not independently associated with major adverse cardiovascular events.
- Only when the fat volume readings were considered alongside a patient’s plaque progression data did it influence 10-year MACE risk predictions.
- However, high EAT volume was independently associated with CAD presence and progression.
So what does this mean for paying attention to fat around the heart?
- For one, it can still be a useful non-invasive biomarker for following statin and GLP-1 therapy impacts on the heart, since both can reduce EAT.
- Moreover, enlarged fat cells release proinflammatory cytokines that could contribute to localized inflammation of the heart tissue, ultimately contributing to heart disease.
- EAT could also eventually find a place among other CAD risk factors like cholesterol, Lp(a), and CAC.
The Takeaway
Fat around the heart isn’t random nor harmless, and while this study does suggest keeping an eye on it can provide some useful information, it’s still unclear how we’ll use that data for clinical decisions.
