title: Epicardial fat and vascular risk: a narrative review.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
authors.forename: Niki
authors.initials: N
authors.lastname: Katsiki
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Wierzbicki
mesh_terms: D050154:Adiposity / Q000187:drug effects; D000818:Animals; D050197:Atherosclerosis / Q000209:etiology*; D002317:Cardiovascular Agents / Q000494:pharmacology; D003324:Coronary Artery Disease / Q000209:etiology*; D006801:Humans; D012307:Risk Factors; D040242:Risk Reduction Behavior
chemical_list: D002317:Cardiovascular Agents