Pericardial Fat an Independent Risk Factor for Heart Failure

Fran Lowry

May 27, 2021

Pericardial fat is associated with a heightened risk for heart failure, particularly in women, new research suggests.

In a prospective cohort study of nearly 7000 individuals, excess pericardial fat was linked to a higher risk for heart failure, even after adjustment for established risk factors for heart failure.

Women with high pericardial fat volume (PFV), defined as more than 70 cc or 2.4 fluid ounces, had double the risk of developing heart failure. For men, high PFV, defined as more than 120 cc or 4.0 fluid ounces, was associated with a 50% increase in the risk for heart failure.

The findings were published in the June 1 issue of the Journal of the American College of Cardiology.

Satish Kenchaiah

"People will ask why should they measure fat around the heart. Why can't they just take the waist circumference or body mass index as a measure for increased risk?" lead author Satish Kenchaiah, MD, MPH, Icahn School of Medicine at Mount Sinai, New York City, told | Medscape Cardiology.

"Yet, when we adjusted for waist circumference, hip circumference, waist to hip ratio, and other known variables, pericardial fat was still associated with an increased risk of heart failure. This tells me that it is not just overall fat in the body but something about its location around the heart that is playing a role," Kenchaiah said.

"Now that we have found an association between any amount of fat around the pericardium and heart failure, it gives us an impetus to build future research on identifying how exactly these fat deposits influence the development of cardiomyopathy," he said.

Kenchaiah and colleagues investigated the association of pericardial fat with incident HF by examining chest CT scans from 6785 participants (3584 women and 3201 men 45 to 84 years of age) in the Multi-Ethnic Study of Atherosclerosis (MESA).

The participants were from four different ethnic groups: 38% were White; 28% were Black, 22% were Hispanic, and 12% were Chinese American. They were recruited between July 17, 2000 and August 31, 2002, from six communities in the United States: Baltimore City and Baltimore County, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan and the Bronx, New York; and St. Paul, Minnesota.

All participants were free of cardiovascular disease at baseline.

The researchers followed participants for more than 17 years. During this time, 385 (5.7%; 164 women and 221 men) developed newly diagnosed heart failure.

In women, the hazard ratio (HR) for every 42 cm3 increase in PFV was 1.44 (95% CI, 1.21 - 1.71; P < .001). In men, the HR was 1.13 (95% CI:, 1.01 - 1.27; P = .03).

High PVF conferred a twofold greater risk for heart failure in women (HR, 2.06; 95% CI, 1.48 - 2.87; P < .001) and a 53% higher risk in men (HR, 1.53; 95% CI, 1.13 - 2.07; P = .006).

These associations remained significant after further adjustment for circulating markers of systemic inflammation (i.e., C-reactive protein and interleukin 6), and abdominal subcutaneous or visceral fat.

They also found that the heightened risk persisted, even after adjustment for established risk factors for heart failure, such as age, cigarette smoking, alcohol consumption, sedentary lifestyle, high blood pressure, high blood sugar, high cholesterol, and myocardial infarction.

Results were similar among all of the ethnic groups studied.

A Surprise Finding

Andreas Kalogeropoulos

"The most surprising part of this study was that the risk for heart failure with increased pericardial fat does not seem to be explained by obesity and systemic inflammation alone," Andreas P. Kalogeropoulos, MD, MPH, PhD, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, told | Medscape Cardiology.

"If pericardial fat was merely a proxy for increased visceral fat, one would expect the association of pericardial fat with heart failure risk to go away after factoring in abdominal CT findings, which was not the case here. Also, accounting for inflammatory markers did not change things dramatically. However, we need to be careful here, as abdominal CT scans have not been done simultaneously with the pericardial fat scans in the study," said Kalogeropoulos, who coauthored an accompanying editorial with Michael E. Hall, MD, University of Mississippi Medical Center, Jackson.

The other striking finding, although not entirely surprising, was the stronger association of pericardial fat with heart failure risk in women, he noted.

"Although several clues have been reported pointing to women being more sensitive to the adverse cardiac effects of pericardial fat, this is the first large prospective study to connect the dots and show much higher risk in women in a convincing way. For the record, this is the first prospective study to show the connection between pericardial fat and heart failure risk altogether," Kalogeropoulos said.

"Obviously, we need to do more work to see how we can use the important findings of Kenchaiah and colleagues to reduce risk for heart failure among patients with increased pericardial fat, especially women. For starters, we would need a way to identify these patients," he said. "In this aspect, it is encouraging that pericardial fat can be measured in low-radiation CT scans, similar to those used for coronary calcium, and that automation technology to speed up pericardial fat measurements is already in the pipeline.

"The next step would be to see what kind of interventions would reduce risk for heart failure in these patients," he added. "Weight loss would be an obvious thing, but novel agents with favorable cardiometabolic effects, like newer antidiabetic medications, are intriguing options, too."

The study was supported by the National Heart, Lung, and Blood Institute and the National Institutes of Health. Kenchaiah and Kalogeropoulos report no relevant financial relationships.

J Am Coll Cardiol. 2021;77:2638-2652; 2653-2655. Abstract, Editorial

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.