EAT and Cardiometabolic Health

Understanding Epicardial Adipose Tissue

Epicardial adipose tissue (EAT) refers to the fatty tissue that envelops the heart. Under normal conditions, EAT is essential for heart function and provides protective benefits for overall health. However, in certain pathological states, EAT becomes a contributing factor to cardiometabolic diseases such as obesity and insulin resistance. Thus, maintaining a healthy balance of EAT is crucial for cardiometabolic well-being.

The Role of EAT in Heart Function

EAT begins to offer protective benefits even before birth. It serves as an energy source for the heart, aids in regulating blood flow, and shields the heart from various forms of damage, including excessive inflammation. As individuals age, the structure of EAT changes, which can impact its functions; however, its protective properties generally remain intact. Traditionally, research on cardiometabolic diseases has focused on obesity, but newer studies have shifted attention toward the unique fatty tissues of specific organs, including EAT. This tissue can have both regional and systemic effects on cardiometabolic health, increasing interest in its study.

EAT and Chronic Disease Development

EAT is linked to the onset of chronic diseases such as atrial fibrillation, diabetes, heart failure, and coronary artery disease. The mechanisms by which EAT contributes to these conditions are complex and not yet fully understood.

Impact of EAT on Inflammation and Heart Health

In pathological conditions, EAT can foster unwanted inflammation, leading to tissue scarring and disrupting hormone functions that regulate vital bodily processes, including heart rhythm and blood circulation. Moreover, EAT may contribute to the progression of diseases like atrial fibrillation and coronary artery disease by instigating structural changes in the heart. Therefore, treatments aimed at reducing EAT may offer significant benefits for managing cardiometabolic diseases.

Measuring EAT Levels

There are several medical tests available to assess the amount of EAT. Imaging techniques such as 2D echocardiography can evaluate blood flow and measure the thickness of epicardial adipose tissue. Other common methods, including computed tomography (CT) and magnetic resonance imaging (MRI), can calculate the volume and thickness of this tissue. Additionally, functional tests like positron emission tomography (PET) scans can assess inflammation levels associated with EAT.

Lifestyle Changes to Manage EAT

Despite its association with heart diseases, there are several lifestyle modifications that can mitigate the health risks posed by EAT. A balanced diet and regular exercise are effective ways to manage EAT levels. If necessary, medications may also be prescribed.

Medications Targeting EAT

Certain medications used to treat type 2 diabetes and high cholesterol have been found to positively influence the cardiometabolic implications of EAT. These drugs exhibit pleiotropic effects, meaning they have additional benefits beyond their primary indications. A comprehensive review by Myasoedova and colleagues examined the effects of various cardiometabolic medications on EAT reduction. The study highlighted three drug categories: glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose co-transporter-2 inhibitors (SGLT2-is), and statins. The findings revealed that GLP-1 RAs had the most significant impact on reducing EAT, followed by SGLT2-is and statins. Notably, the best results were observed after six months of treatment, particularly among patients with a higher body mass index (BMI) and younger age.

The Future of EAT Research

EAT is a modifiable risk factor for cardiometabolic diseases. Adopting a healthy lifestyle, combined with medications when necessary, can facilitate the reduction of heart fat and help achieve a balance between protective and harmful factors. Future research focusing on optimal EAT thickness and the biological mechanisms behind abnormal EAT activity will enhance our understanding and may prevent serious health complications.

References

Iacobellis G. Epicardial adipose tissue in contemporary cardiology. Nat Rev Cardiol. 2022;19(9):593-606. doi:10.1038/s41569-022-00679-9
Çinier G, Nalbantgil S. Epicardial fat: More than an adipose tissue. Turk Kardiyol Dern Ars. Sep 2021;49(6):427-429. https://jag.journalagent.com/tkd/pdfs/TKDA_49_6_427_429.pdf
Myasoedova VA, Parisi V, Moschetta D, et al. Efficacy of cardiometabolic drugs in reduction of epicardial adipose tissue: A systematic review and meta-analysis. Cardiovascular Diabetology. 2023/01/31 2023;22(1):23. https://doi.org/10.1186/s12933-023-01738-2