Role of systemic and epicardial adipose tissue in cardiometabolic disease.
Authors
Affiliations (14)
Affiliations (14)
- Cardiovascular Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
- Imaging Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
- Department of Cardiology, Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia.
- Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia.
- Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia.
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
- Department of Imaging, Cedars-Sinai Medical Centre, Los Angeles, CA, USA.
- Department of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia.
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
- Imaging Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. [email protected].
- Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia. [email protected].
- Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia. [email protected].
Abstract
Adipose tissue is increasingly recognized as an immunological and metabolic organ composed of multiple specialized depots that exert diverse effects on cardiometabolic health. Beyond total adiposity, the distribution and phenotypic state of regional adipose tissue depots, including visceral, subcutaneous and epicardial adipose tissue, contribute to shaping overall cardiovascular risk. These depots communicate with the vasculature and myocardium through endocrine, paracrine, vasocrine and neural pathways to mediate cardiovascular inflammation and remodelling. Advances in cardiac CT, MRI, dual-energy X-ray absorptiometry and artificial intelligence technologies in the past 5 years have resulted in highly reproducible measurements of adipose tissue volume, quality, density and radiomics. Emerging multiomics data now reveal how specific adipose tissue patterns correspond to pathways of inflammation and the development of cardiovascular disease. In this Review, we synthesize the current evidence across adipose depots, highlighting how their collective biology, more so than quantity alone, shapes cardiometabolic risk. Furthermore, we highlight emerging insights into adipose depot-specific biology, imaging phenotyping, ethnicity-related and sex-related differences, and potential therapeutic modulation. We also introduce the 'unified adipose tissue' model that conceptualizes all adipose tissue depots as components of a unified system, in which the biology rather than the total mass of adipose tissue drives cardiometabolic disease.