Excess fat, which forms in the sinus-like membrane surrounding the heart (pericardium), increases the risk of heart failure in women more than in men, regardless of a person’s weight, according to new research published in the Journal of the American College of Cardiology.
“We know that obesity doubles the risk of heart failure, but we found that excess fat in the pericardium increases this risk, as well as the risk of heart failure,” said study author Dr. Satish Kanchaya, associate professor of medicine and cardiology at the Icahn School of Medicine at Mount Sinai Hospital in New York. Incidence of heart failure associated with known indicators of obesity, such as body mass index and waist circumference.
“These findings highlight that fatty tissue around the heart may be particularly dangerous to heart health,” said Dr. Greg C. Fonaro, professor of cardiovascular medicine at the University of California, Los Angeles, who was not involved in the study.
Being thin does not mean a healthy heart
The study stated that having a healthy body weight does not necessarily protect people from the accumulation of fat around the heart or its related damage.
The study included 6,785 participants, distributed roughly equally between women and men.
The lean participants, defined by the study as having a BMI of less than 25-10%, had a high amount of pericardial fat.
This number jumped to 29% for overweight individuals, that is, those with a BMI between 25 and less than 30, and 55% for the group classified as obese, or participants with a BMI equal to or greater than 30.
The study found that regardless of body weight, the more fat in the pericardium, the greater the risk of heart failure.
“It’s not just the total amount of fat in the body, but the fat that’s concentrated and stored around the heart (which is linked to heart failure),” Kinshaya said.
“There is more to assessing health than knowing body weight,” said Kristen Smith, a registered dietitian and coordinator of the Bariatric Surgery Program at Piedmont Healthcare in Atlanta.
She added: “Anyone may have a normal body mass index and at the same time have fat stored in places in the body that may increase the risk of chronic disease and heart failure.”
“This study is a good example of why healthcare providers need to focus on talking about healthy behaviors, not just body weight,” said Julie Stefansky, a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics.
How do you reduce your chances of developing a “greasy heart”?
Experts say a healthy diet and regular exercise are key to managing excess pericardial fat, and these habits can help prevent it from developing in the first place.
Smith, who is also a spokesperson for the Academy of Nutrition and Dietetics, explained, “It is important to follow a heart-healthy diet that focuses on eating fruits, vegetables, high-fiber whole grains, seafood, nuts, legumes and seeds, as well as eating a small number of meatless meals. Weekly, and incorporate omega-3-rich seafood into at least two meals a week.
Exercise reduces the total amount of fat in the body, including the amount of fat around the heart.
An adequate amount of movement could include brisk walking for 30 to 45 minutes per day, or walking 10,000 steps per day for as many days of the week as possible, Kinshaya noted.
Current American Heart Association physical activity guidelines recommend getting at least 150 minutes per week of moderate-intensity aerobic activity, such as brisk walking or dancing, or 75 minutes of vigorous aerobic activity such as jogging or cycling.
In addition, research has shown that losing weight may reduce fat in the pericardium, and these reductions may help improve overall cardiovascular health.
For those who are obese, and who find it difficult to lose weight through diet changes and exercise, weight loss surgery may help reduce total body fat as well as pericardial fat, according to Kanchaya.
How do people get “greasy heart”?
The human heart expands to fill its chambers with blood and contracts to pump blood to the rest of the body.
Kanshaya explained that the pericardial fat may spread in the cells of the heart muscle, those that contract and pressurize the blood or enter the fat between these cells, and cause hardening of the heart and pump disruption.
Kinshaya added that pericardial fat is also linked to plaques (fatty deposits) in the coronary arteries, which can lead to heart attacks and, consequently, heart failure.
The study, which included a nationally representative sample of nearly 7,000 people aged 45 to 84, excluded those with pre-existing cardiovascular disease and control for non-modifiable risk factors such as age and race, as well as modifiable risk factors such as smoking. Excessive alcohol consumption, high blood pressure, high cholesterol, and diabetes.
The study found that pericardial fat independently increased the risk of heart failure in women and men.
“Importantly, the study shows that even if total body fat, diabetes and other heart failure risk factors are accounted for, there is still an increased risk associated with increased pericardial fat,” Fonaro said.
Women are more at risk of heart failure
Women tend to have less membrane fat than men, according to the study. But women are more likely to develop heart failure due to pericardial fat than men, and every 1.4 fluid ounces of fat around the top to middle portion of the heart increases the risk of heart failure by 44 percent in women and 13 percent in men, the researchers found.
Women with large amounts of pericardial fat have a double risk of heart failure, while men have a 50% higher risk.
Future studies will need to clarify the interpretation of the differences between the sexes, Kenchaya said.
Based on enrollment criteria and study results, all subjects aged 45 to 84 years without prior CVD should be screened for excess pericardial fat volume.
The number of times a person should be examined was not specified, according to Kinchaya.
The level of fat in the pericardium can be determined through a computerized tomography (CT) scan, similar to the process used in the study.
For those with a high amount of fat, it is important to get tested for the following symptoms: high blood pressure, high blood sugar, an abnormal cholesterol level, and any evidence of heart attack or coronary heart disease.
“If you have any of these symptoms, (your health care provider should) intervene immediately,” Kinshaya said.
“Maintaining blood pressure close to normal is very effective in reducing the risk of heart failure,” Fonaro added.
Controlling blood sugar, as well as maintaining normal cholesterol and triglyceride levels, is also key, as is avoiding tobacco use, Stefansky said.
“We don’t have the data yet, but we assume that eating right, staying fit and at a healthy weight, and adjusting risk factors when present, can prevent excess fat from accumulating around the heart,” Kinshaya added.