Epicardial adipose tissue and cardiovascular disease: biology, imaging biomarkers, and therapeutic opportunities

Abstract

Cardiovascular diseases (CVDs) are characterized by high morbidity and mortality rates. Recent studies highlight the significance of epicardial adipose tissue (EAT) in the pathophysiology of coronary artery disease (CAD), arrhythmias, and heart failure (HF), primarily through its direct effects on cardiac structure and function mediated by inflammatory, metabolic, and biomechanical pathways. This review provides a comprehensive overview of the biology and regional variability of EAT, summarizes the molecular mechanisms linking EAT to obesity, aging, and the cardiovascular system, and discusses its potential clinical applications. EAT represents a promising imaging biomarker for CVD, with quantitative features, such as thickness, volume, and density, offering significant value for cardiovascular risk stratification. EAT-targeted therapies hold significant potential for the prevention and management of CVD. Furthermore, this review aims to inspire future research on the development of novel therapeutic strategies for cardiovascular conditions.