Cardiovascular disease (CVD) has the highest mortality rate around the world. Ectopic fat storage surrounding the heart is thought to play a major role in the pathogenesis of Coronary artery disease (CAD).

The development of obesity not only increases fat stored in adipose tissues but also causes lipid deposits (ectopic fat) in and around other organs, like the heart.

According to recent study findings, patients who lost weight after bariatric surgery experienced a decrease in their pericardial fat depots. The morbidly obese undergoing bariatric and metabolic operation would have at least a 50% less chance of cardiac events.

What Causes Cardiovascular Disease?

Having too much adipose tissue (AT) has always been a risk factor related to cardiovascular disease. This adipose tissue is the fat used to store energy which makes up 20-25% of the total body weight of a normal person.[1]

Although adipose tissue is found throughout the body, the distinct adipose that envelops the heart is a more significant risk factor for cardiovascular disease. Obesity causes dysfunction of adipose tissue and failure to store extra triglycerides with weight gain, causing this distinct adipose formation.

Fat Around the Heart

Fat deposits around the heart are a proponent risk related to increased cardiovascular problems. These layers of fat can be separated into 6 different components and each offer different risks to heart-related side effects relative to obesity and morbid obesity.

6 Types of Fat Deposits

Fat Deposits Around the Heart

First, we need to uncover the 3 prefixes used in medical terminology: epi-, on, upon, over … para-, beside, beyond, around … peri-, surrounding (outer).

  1. Epicardial Fat (EF): Visceral fat nested between the heart (epicardium) and the visceral (pericardium) surface.
  2. Paracardial Fat: Known as thoracic fat or intrathoracic fat, the para-cardiac fat is found outside of the parietal pericardium.
  3. Pericardial Fat: The sum of visceral and parietal fat deposits located between the epicardial and paracardial.
  4. Perivascular Fat: Adipose tissue that surrounds arteries, vessels, and organs.
  5. Ectopic Fat: Triglyceride deposits of non-adipose tissue fat cells associated with insulin resistance.
  6. Visceral Fat: Adipose tissue that surrounds abdominal cavity organs.

Risks of Paracardial vs Epicardial Fat

The anti-inflammatory cytokine that improves sensitivity to insulin is known as adiponectin. This substance reduces the circulation of fatty acids and is responsible for triglyceride content in various muscles.

Adiponectin quantity is less prominent in overweight and obese people who are at risk for debilitating heart issues. The adiponectin amounts are reduced while the levels of visceral fat, epicardial fat, and intrathoracic fat are elevated.

Pericardial Fat vs Epicardial Fat

Pericardial Fat, alternatively used as Paracardial Fat, is the adipose tissue that surrounds the heart. Epicardial Fat (EF) is the fat right next to the myocardium. Pericardial adipose tissue, anterior to EF, is associated with an increased risk of cardiovascular disease.

About Bariatric Surgery

Bariatric surgery is the term used for weight loss surgery that helps people lose weight by minimizing how much they can eat. Recent studies have immense success in operation for short-term and long-term success at losing weight and battling a broad range of serious diseases and medical conditions.

Bariatric surgery is shown to improve the function of Adipose Tissues.

The recent mot study was performed to show the type of fat that is decreasing the most, showing that pericardial fat is reduced more than epicardial fat. This means the abdominal fat deposits were reduced the most following bariatric surgery, such as the Roux-en-Y gastric bypass procedure, one of the most common bariatric procedures.

The goal is that by forcing this reduction in food intake, they start losing weight. Bariatric surgery procedures include gastric bypass, lap band surgery, stomach stapling, and sleeve gastrectomy. The results and potential risks of each surgery vary based on the person getting it and what is involved in the procedure.Before and After - Amber 2021 - Mexico Bariatric Center

The Study: Bariatric Surgery Effect on Cardiovascular Fat Deposits

During this study, there was a total of 10 patients were reviewed 16 months after having the Roux-en-Y gastric bypass procedure. There were 60 percent women and 40 percent men in the study, with the average age of patients being 53.7 years old. An MRI machine was used to measure the amount of ectopic fat accumulation, as well as the CV function.

The Myocardial Triglyceride Content (MTGC) was also assessed, by using an MR spectroscopy device. At baseline when the surgery was first performed, the average body mass index (BMI) of the patients was 41.3, and 16 months later, it was 34.1. There was a larger decrease in pericardial fat volume with a decline of 17.3 as opposed to 6.4 of Epicardial Fat Volume (EFV) The study also found a considerable decrease in visceral fat volume at 35.5 lower, as opposed to the subcutaneous fat volume that fell by 25.

Study Results

What these results show, according to the study’s researchers, is that this particular type of gastric bypass procedure is successful at reducing the fat tissues and distributions in the body, not just losing weight overall. However, it should be noted that the reduction in pericardial fat didn’t make a difference in the participant’s cardiovascular function following the gastric bypass procedure.

While the study did not show the reduction of pericardial fat having a significant effect on each person’s cardiovascular function, this doesn’t mean further testing wouldn’t show benefits. Pericardial fat has long since been directly linked to cardiovascular health. Not to mention weight loss in general from the Roux-en-Y gastric bypass procedure shows significant changes in a variety of conditions following weight loss, such as type 2 diabetes, risk of heart disease and stroke, high blood pressure, and high cholesterol levels.

Disclosure

Funding for this study was provided by the Netherlands Heart Foundation and was performed with help by a grant from the Dutch Obesity Clinic, using a framework at the Center for Translational Molecular Medicine. Linda D. Van Schinkel, MD was head of the research team for this study, as a medical doctor and researcher at the Leiden University Medical Center in the Netherlands.

Conclusion

For severely obese patients, significant surgical-induced weight loss with bariatrics is associated with a significant decrease in abdominal and pericardial fat volume and no changes in epicardial and myocardial triglyceride content. It is likely that the beneficial effects of bariatric surgery on pericardial fat are partly responsible for the reduced cardiac death rate seen with weight loss.

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