The role of epicardial fat in the progression of cardiovascular disease in women

Obesity is a global health burden with significant sex-specific implications, especially in cardiovascular disease (CVD). Epicardial fat tissue (EFT), a metabolically active visceral fat depot between the myocardium and visceral pericardium, plays a critical role in cardiac health. Under normal conditions, EFT supports the heart via anti-inflammatory signaling, fatty acid metabolism, and nitric oxide–mediated vasodilation. However, in obesity and cardiometabolic syndrome, EFT becomes proinflammatory, contributing to cardiac remodeling and endothelial dysfunction. Since women experience unique hormonal and metabolic influences, risk factors such as menopause, polycystic ovarian syndrome, vitamin D deficiency, and sleep apnea are linked to increased EFT in women, independent of body mass index, and correlate with adverse cardiac remodeling and inflammation. Therapeutic strategies such as exercise, GLP-1 receptor agonists, and hormone replacement therapy show promise in reducing EFT. Understanding sex-specific EFT biology is essential for personalized CVD prevention and treatment in obesity-related disorders.