Epicardial adipose tissue (EAT) depots, highly specialized adipose tissue (AT) depots, are an important contributor to the development of heart failure (HF), and show a distinct response to obesity, a new state-of-the-art review shows. These data were reported by Just Dronkers, MSc, of the University Medical Center Groningen, the Netherlands, and colleagues, in a manuscript published online Monday and in the November 22 issue of the Journal of the American College of Cardiology. In 2022, over 1 billion adults worldwide had obesity, defined as a body mass index (BMI) > 30 kg/m2. Obese patients are at significantly higher risk for cardiovascular disease development. Patients with obesity are at double the risk for developing HF compared to non-obese patients. HF with preserved ejection fraction (HFpEF) is specifically associated with obesity. The relationship between HFpEF still has many unanswered questions, in-part due to the fact that the method of determining obesity (the BMI scale) does not account for the location of AT. EAT, for example, may contribute to HFpEF development and is located around the myocardium. Additionally, subcutaneous AT and visceral AT contribute to the development of HF, and both these types of AT are in the abdominal region. Targeting properties of these different types of fat tissue may be useful in future approaches to reducing and treating incident HFpEF. This review suggested three potential mechanisms as to how EAT contributes to the development of HF: proinflammatory paracrine effects, infiltration and cardiac lipotoxicity and pericardial constraint leading to diastolic dysfunction. The investigators in this review suggest future studies focus on the properties of EAT to develop novel targets for the management of HF and HFpEF. Overall, location of AT development, particularly around the heart and abdominal region, is a component of obesity that may lead to the development of HF. Source: Dronkers J, van Veldhuisen DJ, van der Meer P, et al. Heart failure and obesity: Unraveling molecular mechanisms of excess adipose tissue. Journal of the American College of Cardiology. 2024;84:1666-1677. Image Credit: Africa Studio - stock.adobe.com