Adipose tissue biology and distribution, rather than total mass alone, drive cardiometabolic disease risk through complex endocrine, paracrine, vasocrine, and neural pathways.
Adipose tissue is increasingly recognized as an immunological and metabolic organ composed of multiple specialized depots that exert diverse effects on cardiometabolic health. Beyond total adiposity, the distribution and phenotypic state of regional adipose tissue depots, including visceral, subcutaneous and epicardial adipose tissue, contribute to shaping overall cardiovascular risk. These depots communicate with the vasculature and myocardium through endocrine, paracrine, vasocrine and neural pathways to mediate cardiovascular inflammation and remodelling. Advances in cardiac CT, MRI, dual-energy X-ray absorptiometry and artificial intelligence technologies in the past 5 years have resulted in highly reproducible measurements of adipose tissue volume, quality, density and radiomics. Emerging multiomics data now reveal how specific adipose tissue patterns correspond to pathways of inflammation and the development of cardiovascular disease. In this Review, we synthesize the current evidence across adipose depots, highlighting how their collective biology, more so than quantity alone, shapes cardiometabolic risk. Furthermore, we highlight emerging insights into adipose depot-specific biology, imaging phenotyping, ethnicity-related and sex-related differences, and potential therapeutic modulation. We also introduce the ‘unified adipose tissue’ model that conceptualizes all adipose tissue depots as components of a unified system, in which the biology rather than the total mass of adipose tissue drives cardiometabolic disease.
Khanna et al. (Tue,) conducted a review in cardiometabolic disease. Adipose tissue distribution and biology was evaluated. Adipose tissue biology and distribution, rather than total mass alone, drive cardiometabolic disease risk through complex endocrine, paracrine, vasocrine, and neural pathways.