Pericardial Fat Associated With Increased Risk of Heart Failure

Heart fat deposits. Gross specimen of tissue from inside a heart that has fat deposits (white). This is a fatty heart, a heart that has accumulated adipose (fat) tissue. In severe cases, fat deposits infiltrate between the muscle bundles of the heart wall. Generally seen in obese patients, the fatty heart can function poorly and lead to degeneration of the muscle and cardiac failure.
Study authors examined the association between pericardial fat volume and newly diagnosed heart failure.

Both women and men with higher pericardial fat may be at increased risk for heart failure with preserved ejection fraction, according to a study recently published in the Journal of the American College of Cardiology.

This ethnically diverse, community-based, prospective cohort study included 6785 individuals (3201 men, 3584 women; mean pericardial fat, 80±42 cm3; interquartile range (IQR) 49-100 cm3) aged 45 to 84 years from the Multi-Ethnic Study of Atherosclerosis. Total follow-up was 90,686 person-years (median, 15.7 years). All participants had no history of clinical cardiovascular disease. Classifications of heart failure included definite, probable, and absent; pericardial fat was treated as a continuous and dichotomous variable using Cox proportional hazards regression with a maximized J-statistic.

Among the study population, 5.7% (n=385; 164 women, 221 men) of study participants were newly diagnosed with heart failure. Women had lower pericardial fat than men (69±33 vs 92±47 cm3, respectively; P <.001). Using the Youden index, the optimal normal or high cutoff value for dichotomous pericardial fat was 69.8 cm3 for women and 120.6 cm3 for men.

Multivariable Cox regression showed that in women, a 1-SD increase (42 cm3) in pericardial fat correlated with a 68% (95% CI, 42%-98%; P <.001) increase in the risk of heart failure, which fully adjusted models reduced to a 44% (95% CI, 1.21%-1.71%; P <.001) increase. In men, a 1-SD increase in pericardial fat was associated with a 24% (95% CI, 12%-37%; P <.001) increase in heart failure risk, or 13% (95% CI, 1.01-1.27; P =.03) in fully adjusted models.

High pericardial fat was associated with a significantly higher risk of heart failure in women (hazard ratio [HR] 2.06; 95% CI, 1.48-2.87; P <.001) and men (HR 1.53; 95% CI, 1.13-2.07; P =.006). Among all participants, heart failure risk was still strong with additional adjustments for obesity, inflammation and hemodynamic stress biomarkers, and abdominal subcutaneous or visceral fat. Ethnicity did not significantly affect the risk (P =.24). Higher pericardial fat increased the risk of heart failure with preserved ejection fraction compared with lower ejection fraction (P =.31).

Limitations of these findings included limiting study to a portion of rather than the full heart, an inability to distinguish epicardial and pericardial fat repositories, noncomprehensive data on abdominal subcutaneous and visceral fat, the need for further validation on normal or high threshold values for pericardial fat in men and women, and concerns regarding radiation exposure during examinations.

The study researchers concluded that the “greater amount of pericardial fat was associated with a higher risk of [heart failure] in both women and men and about one-fifth of newly diagnosed [heart failure] . . . was attributable to high [pericardial fat].” Clinically, investigators indicated that “Excess pericardial fat should be considered as a novel risk factor for [heart failure].”


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