Association between Cardiac Adiposity and Memory-Related Cognitive Performance: A Systematic Review and Meta-Analysis

Background: Emerging data reveal that increased cardiac adipose accumulation may be linked to poor memory-related cognitive function via several processes. However, the relationship between cardiac adiposity and memory performance remains unclear. We sought to determine the relationship between cardiac adiposity, defined primarily as epicardial and/or pericardial adipose tissue, as well as a related cardiovascular adipose depot (thoracic perivascular adipose tissue), and memory-related cognitive performance, as well as to identify sources of heterogeneity among studies. Methods: A systematic and comprehensive electronic literature search was conducted in PubMed (MEDLINE), Scopus, and EMBASE from database inception to October 30, 2025. A random-effects model was used to calculate the pooled harmonized effect estimate and 95% confidence interval (CI) for the relationship between cardiac adiposity and memory performance. Results: Five studies comprising 1,444 participants were included. Higher cardiac adiposity was significantly associated with poorer memory-related cognitive performance (random-effects = 0.448; 95% CI: 0.294–0.680; P < 0.001). Exploratory subgroup analyses showed significant inverse associations in studies involving participants aged > 60 years and those using transthoracic echocardiography (random-effects = 0.238; 95% CI: 0.144–0.393; P < 0.001 for both), but not in studies involving participants aged < 60 years or using computed tomography (random-effects = 0.899; 95% CI: 0.589–1.371; P = 0.621 for both). Studies without major comorbidities showed a significant inverse association (random-effects = 0.167; 95% CI: 0.054–0.518; P = 0.002), whereas studies involving participants with cardiometabolic comorbidities showed no significant association. Conclusion: Cardiac adiposity was linked to lower memory-related cognitive function. However, the significant heterogeneity necessitates a careful interpretation of these results.