- There are two types of fat that directly damage the heart: visceral (abdominal) fat and epicardial (around-the-heart) fat
- Both types share the same embryological origin — meaning increased visceral fat reliably predicts increased epicardial fat
- Waist circumference is a practical, accurate proxy for both visceral and epicardial fat burden
- Epicardial fat causes direct and indirect cardiovascular damage — including heart failure, atherosclerosis, arrhythmias, and hypertension
- A 5–10% reduction in body weight significantly reduces visceral and epicardial fat, lowering cardiovascular risk
Two Types of Fat That Threaten the Heart
Not all body fat carries the same cardiovascular risk. The fat stored beneath the skin (subcutaneous fat) is relatively metabolically inert. The two types of fat most directly linked to heart disease are quite different — and both are closely interconnected:
Fat stored around the internal organs — the liver, intestines, and other abdominal structures. Metabolically active, releasing pro-inflammatory cytokines that circulate throughout the body and damage blood vessels and organs.
Fat deposited within the outermost layer of the heart (the epicardium), alongside blood vessels, nerves, and connective tissue. Has direct contact with the heart muscle and coronary arteries, enabling localised inflammatory damage.
Waist Circumference as a Proxy for Heart Fat
While epicardial fat can only be measured directly with specialised cardiac imaging, there is a practical and clinically validated alternative: waist circumference.
Because visceral fat and epicardial fat share the same origin and behave similarly, an increased waist circumference tells us that visceral fat is elevated — and allows us to reliably infer that epicardial fat is elevated too. This is one of the key reasons waist circumference is such a clinically valuable metabolic health marker. Learn more about measuring waist circumference.
How Epicardial Fat Damages the Heart
Increased epicardial fat causes both direct and indirect damage to the heart and blood vessels — and some of this damage can be irreversible if it progresses unchecked. The five key cardiovascular consequences are:
Particularly heart failure with preserved ejection fraction (HFpEF) — a form increasingly linked to excess epicardial fat and inflammation
Narrowing of the coronary and peripheral arteries driven by inflammation and lipid deposition — the underlying cause of most heart attacks
Including atrial fibrillation (AF) — which significantly increases stroke risk. Epicardial fat directly infiltrates and disrupts atrial tissue
Including deep vein thrombosis (DVT) and stroke — driven by the pro-inflammatory, pro-thrombotic state associated with elevated visceral and epicardial fat
High blood pressure — itself a major risk factor for heart attack, stroke, kidney failure, and heart failure. Adipose tissue directly disrupts blood pressure regulation
Prevention Is the Most Powerful Treatment
When it comes to cardiovascular disease caused by excess adipose tissue, prevention is the most effective strategy available — because some forms of cardiac damage, once established, are irreversible. This makes early action on visceral and epicardial fat critically important.
The evidence is clear: a reduction of just 5–10% of total body weight produces measurable, clinically significant reductions in visceral and epicardial fat — and with it, a meaningful reduction in cardiovascular risk. This is one of the most compelling arguments for early, evidence-based treatment of overweight and obesity.
At MedSurg Weight Loss, metabolic and cardiovascular health is at the centre of everything we do. We use evidence-based treatments for overweight and obesity that directly reduce visceral fat — and with it, epicardial fat and cardiovascular risk. Get in touch to book an assessment, or explore our Medical Weight Loss and Metabolic Health services.
Medical disclaimer: This article is for general educational purposes only. If you have concerns about your cardiovascular health, please consult your doctor for a personalised assessment and management plan.