Epicardial Fat and Hepatic Steatosis as Cardiovascular Risk Markers

espanolEl tejido adiposo epicardico (TAE) es el deposito graso visceral intratoracico localizado entre el miocardio y el pericardio, en intimo contacto con las arterias coronarias en todo su trayecto. Considerado historicamente como un simple deposito de energia, el TAE es un tejido metabolicamente activo que ha cobrado gran interes en la ultima decada como marcador de riesgo cardiovascular. Tanto el TAE como el tejido adiposo visceral abdominal, de mismo origen embriologico, se relacionan con la produccion de citoquinas proinflamatorias y de acidos grasos libres (AGL), con la promocion de un estado de hipercoagulabilidad, y con numerosos factores de riesgo cardiometabolico. En particular, los pacientes diabeticos evidencian un mayor volumen de TAE, con un perfil metabolicamente mas activo y proinflamatorio independientemente de los otros factores de riesgo cardiovasculares EnglishEpicardial adipose tissue (EAT) is a metabolically active tissue which has raised great interest in the last decade as a cardiovascularrisk marker. It is related with the production of proinflammatory cytokines and free fatty acids, the promotion of a state of hypercoagulabilityand with numerous cardiometabolic risk factors. Between EAT and coronary arteries, there is not only an intimateanatomical association, but also bidirectional physiological aspects of paracrine regulation. In addition, several studies have founda relationship between EAT and endothelial dysfunction, non-obstructive atheromatosis, oxidative stress, atrial fibrillation anddiastolic dysfunction.Parallel to these findings, there is a tight association between hepatic steatosis (the most prevalent chronic hepatic disease), coronaryatheromatosis and cardiovascular risk. One of the interesting and differential characteristics of hepatic steatosis with respectto coronary artery disease is its dynamic, and to a certain point reversible, character.Despite their association with atheromatosis and cardiovascular risk, and simple assessment from non-invasive imaging methods,epicardial fat and non-alcoholic fatty liver are seldom considered as risk markers in clinical practice.