Do You Have a Fatty Heart?

By Thomas Galski, DO, FACC, Cardiologist – Virtua Cardiology

There’s usually no hiding from fat. We see it every time we look in the mirror or try to zipper a favorite pair of jeans.

But there’s a type of fat that we can’t see that poses a risk to our heart health. Pericardial fat—fat stored around the heart and in the upper chest—is linked to a greater chance of developing heart failure, atrial fibrillation, and plaque buildup in the coronary arteries that can lead to a heart attack.

The Fat Within
Pericardial fat, sometimes called “fatty heart,” is a type of visceral fat. Visceral fat wraps around your abdominal organs deep inside your body and produce proteins that cause harmful inflammation. 

The best way to tell where and how much visceral fat you have is with an imaging test, such as a CT scan or MRI. However, you may have visceral fat if you have a:

  • Waist size greater than 35 inches for women or 40 inches for men
  • Body mass index (BMI) of 30 or higher
  • Body shape like an apple—a big trunk and slimmer legs

Carrying too much visceral fat raises your risk for developing heart disease, type 2 diabetes, stroke, breast cancer, colorectal cancer and Alzheimer’s disease.

No Protection for Being Thin
High amounts of pericardial fat can increase your risk for heart failure and other conditions, regardless of your body weight.

A study recently published in the Journal of the American College of Cardiology found that 10% of people with a BMI of less than 25 still had a high amount of pericardial fat. That number jumped to 29% for people with a BMI of 25 to 30, and 55% for people with a BMI of 30 or greater.

The researchers found that while women usually have less pericardial fat than men, those who had high amounts had double the risk of developing heart failure. Men with fatty hearts had a 53% greater risk for heart failure.

The connection held true when adjusted for other well-known risk factors for heart failure, including age, tobacco use, alcohol consumption, sedentary lifestyle, hypertension, high cholesterol, and previous heart attack.
How Hidden Fat Harms Your Heart
Heart failure occurs when your heart weakens and cannot pump enough oxygen-rich blood to support the body’s needs. 

This weakening often is the result of damage to the heart from a heart attack, coronary artery disease, chronic high blood pressure, abnormal heart rhythms, faulty heart valves, cardiomyopathy (an enlarged heart), or myocarditis (inflammation of the heart, usually caused by a virus).

Pericardial fat, however, has a different influence. Pericardial fat can accumulate within the cells of the heart, interfering with its ability to pump blood effectively. Over time, this can lead to heart failure.

Pericardial fat poses another threat to your heart health. Like abdominal visceral fat, pericardial fat is metabolically active, releasing inflammatory substances that speed up the development of plaque in your coronary arteries, called atherosclerosis. Too much plaque clogging your arteries heightens your risk for a heart attack, and subsequently heart failure.

The same inflammation that affects the arteries also may scar the heart and cause atrial fibrillation, a type of irregular heartbeat that increases your risk for blood clots and stroke.  

Improve Your Heart Health
To reduce the amount of pericardial fat you may have, work on habits that improve your heart health overall. Try to:

  • Exercise. Aim for at least 30 minutes of moderate aerobic exercise each day. Be sure to include strength training to build your muscles.
  • Eat a Mediterranean-style diet rich in fresh fruits and vegetables, whole grains, low-fat dairy, lean proteins, legumes, olive oil, nuts, and seeds. Avoid foods high in trans fats, added sugars, and sodium.
  • Drink alcohol in moderation.
  • Work with your doctor to lower your blood pressure, cholesterol, and blood sugar.

Heart Care in Your Neighborhood
Virtua’s team of more than 100 cardiac experts provides comprehensive cardiac care, from medical cardiology to interventional procedures to advanced cardiac surgery. Appointments are available within 48 hours. Call 888-847-8823.

Updated June 15, 2021

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