Possible Link Seen Between Pericardial Fat, Heart Failure Risk

Mount Sinai research released today shows a possible link between excess pericardial fat and greater risk of heart failure, with implications for early intervention and prevention of heart disease.

The likelihood of developing heart failure was higher among both women and men in the presence of excess pericardial fat, according to Mount Sinai research published today in Journal of the American College of Cardiology.

This risk was similar after accounting for known heart failure risks of age, cigarette smoking, alcohol use, sedentary lifestyle, hypertension, hyperglycemia, hypercholesterolemia, and history of myocardial infarction and regardless of lean, overweight, or obese body weight classification.

“For nearly 2 decades we have known that obesity, based on simple measurement of height and weight, can double one’s risk of heart failure, but now we have gone a step further by using imaging technology to show that excess pericardial fat, perhaps due to its location close to the heart muscle, further augments the risk of this potentially fatal condition—heart failure,” said lead researcher Satish Kenchaiah, MD, associate professor of medicine (cardiology) at the Icahn School of Medicine at Mount Sinai, in a statement.

Investigators used chest CT scans from the Multi-Ethnic Study of Atherosclerosis study, finding an overall 5.6% occurrence of heart failure over a median (interquartile range) 15.7 (11.7-16.5) years of follow-up among the 6785 participants (aged 45-84 years; women, n = 3584; men, n = 3201), and none with heart disease at the study’s inception.

The definitions for high pericardial fat volume (PFV) differed according to sex: 70 cm3 for women (2.4 fl oz) and 120 cm3 for men (4.0 fl oz).

Despite more men than women with excess PFV developing heart failure (6.9% vs 4.6%) and the women having a lower mean (SD) PFV (69 [33] vs 92 [47] cm3; P < .001), the women still had twice the risk of developing new-onset heart failure (HR, 2.06; 95% CI, 1.48-2.87; P < .001). The men had just a 53% increased risk (HR, 1.53; 95% CI, 1.13-2.07; P = .006).

Adjusting for sex-related anthropometric obesity indicators (P ≤ .008), abdominal subcutaneous or visceral fat (P ≤ .03), and inflammation/hemodynamic stress (P < .001) showed a similar heart failure risk across the 4 racial groups represented in the study (White, Black, Hispanic, and Chinese).

At baseline, mean body mass index, waist circumference, and hip circumference were all lower among those with a normal PFV vs high PFV (all P < .001). This was similar between the sexes. However, more women than men had a history of cigarette smoking and alcohol use.

Overall, a multivariable analysis found that every 1 SD (42 cm3) PFV increase indicated a higher risk of heart failure among the sexes:

  • Women had an HR of 1.44 (95% CI, 1.21-1.74; P < .001)
  • Men had an HR of 1.13 (95% CI, 1.01-1.27; P = .03)

This risk was greater among the persons with heart failure with preserved ejection fraction (P < .001) compared with reduced ejection fraction (P = .31).

The authors’ findings of a statistically significant association between PFV and heart failure diagnosis indicated a strong possibility that pericardial fat “is not just a surrogate for abdominal fat depot, but that its specific location around the heart may have a causal implication for the development of heart failure,” they noted.

PFV should be considered a risk factor, they concluded. Still, they emphasized, future studies are necessary “to differentiate the relative contribution of epicardial and paracardial fat depots, particularly given known differences in their embryological, anatomic, biochemical, biomolecular, and physiopathological profiles, to the risk of heart failure.”

The impact of lifestyle modifications and therapies that focus on reducing fat depots around coronary arteries and the heart should also be studied.


Kenchaiah S, Ding J, Carr JJ, et al. Pericardial fat and the risk of heart failure. J Am Coll Cardiol. 2021;77(21):2638-2652. doi:10.1016/j.jacc.2021.04.003

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