Epicardial Fat

In a lean healthy body, a thin layer of epicardial fat provides energy to the heart, insulates coronary arteries from cold, and cushions cardiac structures. Bariatric surgery has been associated with significant reductions in epicardial adipose tissue thickness. Epicardial fat responds particularly well to cold exposure including cold showers and cold immersion. Epicardial fat is beige in color rather than the yellow typical of subcutaneous fat, indicating it is metabolically distinct. The Framingham Heart Study identified epicardial adipose tissue as an independent cardiovascular risk factor. Epicardial fat is present in nearly 100% of open-heart surgery cases, surrounding the heart as a layer of visceral fat. Epicardial fat directly contacts the heart muscle and the coronary arteries. When visceral fat is elevated, epicardial fat can expand and become pro-inflammatory, delivering inflammatory compounds directly into coronary vessels and heart muscle. Pathological epicardial fat releases TNF-alpha and IL-6 directly into neighboring coronary vessels and myocardium without requiring long bloodstream transit or dilution. Because of its direct contact with the heart, inflammation fro…