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Cardioprotective Heme Oxygenase 1‐PGC1α Signaling in Epicardial Fat Attenuates Cardiovascular Risk in Humans as in Obese Mice

Epicardial fat is a peculiar visceral fat with unique anatomical, genetic, and functional features (2). Depending on the circumstances, epicardial adipose tissue displays both favorable, such as thermogenic and mechanical, and pathological properties. Because of its direct and unobstructed contiguity to the myocardium, epicardial fat can regulate or affect the underlying coronary arteries and cardiomyocytes throughout vasocrine and paracrine release of bioactive molecules (2). As a result of an imbalance between protective and detrimental functions, human epicardial fat, highly enriched in genes coding for proinflammatory and profibrotic cytokines, plays a major role in the development and progression of coronary atherosclerosis (2). Its measurability with noninvasive imaging methods, and the significant response to pharmaceutical agents modulating the adipose tissue, make epicardial fat a novel risk factor and therapeutic target (3).