Physiology and Cardioprotection of the Epicardial Adipose Tissue

Epicardial adipose tissue (EAT) is a peculiar visceral fat depot with both protective and detrimental properties. The physiological role of EAT within the heart is complex and not completely understood. EAT functions can be distinguished in (1) nutritional, (2) metabolic, (3) thermogenic, (4) regulatory, and (5) mechanical. Under normal physiological EAT serves as a buffer, absorbing fatty acids and protecting the heart against high fatty acids levels and as pad protecting abnormal curvature of the coronary arteries. EAT is enriched in genes coding for cardioprotective adipokines such as adiponectin and adrenomedullin, both with potential anti-inflammatory and anti-atherogenic properties. EAT could also function as local energy source at times of high demand, channeling fatty acids to the myocardium and as brown fat to defend the myocardium against hypothermia. EAT expresses genes and secretes cytokines actively involved in the thermogenesis and regulation of lipid and glucose metabolism of the adjacent myocardium. EAT may adapt itself to different metabolic circumstances and function as brown-like or beige fat depot as needed