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Adipocyte and Cell Biology

Heart-guarding or heart-harming? The dual role of epicardial adipose tissue in cardiovascular health and disease

International Journal of Obesity (2025)Cite this article

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Abstract

Epicardial adipose tissue (EAT), nestled directly against the beating heart, is a fascinating paradox in cardiovascular biology. In health, this unique fat depot functions as a metabolic ally and immune modulator, safeguarding the heart through energy support, anti-inflammatory actions, and mechanical cushioning. Yet, under pathological conditions, EAT transforms from a protective “heart-guardian” into a destructive “heart-harmer,” releasing pro-inflammatory mediators, driving oxidative stress, and fueling cardiovascular diseases like coronary artery disease (CAD) and atrial fibrillation (AF). This review explores EAT’s dual role, unraveling its complex biology and the delicate balance between protection and pathology. We delve into its cellular and molecular intricacies, highlight its pivotal contributions to cardiovascular health and disease, and synthesize cutting-edge research to illuminate its clinical relevance. By identifying current knowledge gaps and proposing future directions, we aim to inspire a deeper understanding of EAT and its potential as a therapeutic target. As we navigate this duality, EAT emerges as both a challenge and an opportunity in the quest to better understand and treat cardiovascular diseases.

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Fig. 1: Anatomical distribution and cross-sectional localization of EAT.
Fig. 2: Cellular composition and secretory factors of EAT.
Fig. 3: The dual role of EAT in cardiac physiology and pathology.
Fig. 4: Effects of External Interventions on EAT.

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Acknowledgements

We are grateful to all of our colleagues from our research group who provided insightful feedback and suggestions during the preparation of this review.

Funding

This work was supported by National Natural Science Foundation of China (Grant No. 32400767) and General Program of Basic Science (Natural Sciences) Research for Higher Education Institutions in Jiangsu Province (24KJB180001).

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Authors and Affiliations

  1. Northern Jiangsu Cardiovascular Disease Prevention and Treatment Research Institute, Jiangsu University, Yan Cheng, China

    Yu Tian & Zhifeng Dong

  2. School of Life Sciences, Jiangsu University, Zhenjiang, China

    Yu Tian

  3. Taizhou Second People’s Hospital Affiliated to Yangzhou University, Taizhou, China

    Pingping Wang

  4. Department of Cardiovascular Medicine, Yancheng Third People’s Hospital, Yancheng, China

    Zhifeng Dong

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  1. Yu Tian
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  2. Pingping Wang
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  3. Zhifeng Dong
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Contributions

Yu Tian: Writing—original draft, Visualization. Pingping Wang: Supervision, Writing—Review and editing. Zhifeng Dong: Project administration, Conceptualization. Yu Tian and Pingping Wang contributed equally.

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Correspondence to Zhifeng Dong.

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Tian, Y., Wang, P. & Dong, Z. Heart-guarding or heart-harming? The dual role of epicardial adipose tissue in cardiovascular health and disease. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01852-z

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