Epicardial Fat: The Overlooked Risk Factor for Heart Disease

Weight. Stress. Diet. Lifestyle.

We’ve all heard it before – you need to change this or tweak that if you want to improve your cardiovascular health for the long term.

But what if there’s something more? What if there’s something you haven’t heard of, that few people have heard of, that may be hurting your heart and worsening your cardiovascular health without you ever even knowing?

While well-known risk factors like high blood pressure, cholesterol, and smoking dominate health discussions, there’s a lesser-known culprit that deserves attention: epicardial fat.

This hidden fat surrounds the heart, and actually directly impacts your coronary arteries – even in people with a normal body mass index (BMI).

Let’s get right into it…

What Is Epicardial Fat?

Epicardial fat is a type of visceral fat right between your heart muscle (myocardium) and its outer covering (pericardium). Unlike subcutaneous fat, which is under your skin, this epicardial fat is metabolically active. In other words, it releases hormones and inflammatory molecules that can directly affect your heart and arteries.

Although some level of epicardial fat is normal and fine, used for cushioning the heart and providing energy, too much of it can trigger serious health issues. Many studies estimate that epicardial fat accounts for about 20 percent of total heart fat, with its volume varying widely between individuals.

Basically, it all comes down to your genetics, diet, and lifestyle.

For Black individuals, systemic factors like stress, lack of quality nutrition, and higher rates of cardiovascular conditions can all add to epicardial fat volume. Even when at similar BMI levels, Black individuals may have higher levels of epicardial fat due to these problematic factors.

The Dangers of Excess Epicardial Fat

Excess epicardial fat is not just a passive deposit; it plays an ongoing role in your health and wellness.

There are various ways that too much of this fat can impact your body:

Increased Arterial Plaque: Because epicardial fat is in direct contact with your coronary arteries, it may release pro-inflammatory molecules that promote atherosclerosis, the buildup of plaque in arteries. One study from Circulation found that higher epicardial fat volume was associated with a 30 percent increased risk of coronary artery calcification, which is a key predictor of heart attacks.
Higher Diabetes Risk: Epicardial fat also contributes to insulin resistance by releasing free fatty acids that affect the way your body handles glucose or blood sugar. Some studies indicate that people with high epicardial fat have a 2.5 times higher risk of developing type 2 diabetes, even if they have a normal BMI.

This is particularly concerning for Black adults, who have a significantly higher diabetes prevalence than White adults.

Abnormal Heart Rhythms: Excess epicardial fat sometimes disrupts the heart’s electrical activity, increasing the risk of atrial fibrillation (AFib). In one European Heart Journal study, higher epicardial fat was associated with a 40 percent increased AFib risk, allowing fat to infiltrate the heart muscle and alter its conduction pathways.
Heart Failure Risk: Finally, epicardial fat can also stiffen your heart muscle, impairing its ability to pump effectively. Over time, this contributes to heart failure, which is already more common in Black populations.

And here’s what makes epicardial fat so secretive and sneaky…

You can’t gauge epicardial fat simply by looking in the mirror or stepping on the scale. Many people with normal BMIs (18.5–24.9) have excess epicardial fat, especially when they have certain genetics and poor diets. This is the main reason epicardial fat is a “forgotten” but critical risk factor.

Assessing Epicardial Fat

Unlike waist circumference or BMI, epicardial fat can only be detected and measured with specialized imaging. Fortunately, there are many main methods to determine if your epicardial fat levels are problematic.

For starters, you can have your doctor perform what is called computed tomography (CT). This CT scan provides detailed 3D images of your epicardial fat volume. According to most research, epicardial fat volumes above 70 cm³ are associated with higher cardiovascular risk.

Although the CT is highly accurate, it does involve radiation exposure, so it’s often reserved for high-risk patients only.

Another method used is magnetic resonance imaging, commonly called an MRI. If you’re unfamiliar with MRIs, they offer a radiation-free way to assess epicardial fat thickness and volume. MRIs are particularly useful for tracking changes over time.

Research indicates that MRI-detected epicardial fat correlates strongly with insulin resistance in Black adults. In other words, prediabetes and diabetes.

Finally, your healthcare provider can use what is known as an echocardiography. While this ultrasound-based method measures epicardial fat thickness, it’s less precise than CTs or MRIs. That said, it is widely available and radiation-free. Typically, a thickness above 7 mm is linked to an increased heart disease risk that must be monitored.

Not sure where to start? Consult a cardiologist, especially if you have risk factors like hypertension, diabetes, or a family history of heart disease. Advocating for these tests can be lifesaving, so don’t hesitate even if they aren’t the usual routine tests doctors give.

And if your healthcare provider does find that you have problematic levels of epicardial fat, there are various steps you can take.

Actionable Strategies

While everything you’ve read so far may be alarming, there is great news. Epicardial fat is responsive to lifestyle changes. In fact, there are numerous evidence-based ways to reduce it and protect your heart.

The first step you should consider is increasing your aerobic exercise. Regular exercise is key – it doesn’t have to be super intense. We’re talking brisk walking, running, cycling, dancing, or some other activity that gets you breathing a bit.

The Journal of the American Heart Association study finds that 150 minutes of moderate aerobic exercise per week (e.g., 30 minutes, five days a week) can have marked impacts on the amount of epicardial fat. Even if you don’t lose any weight, the benefits still remain.

For Black individuals, community-based activities like group fitness classes or walking clubs can make all the difference.

And of course, don’t forget to watch what you eat! Reduce your calorie intake, specifically from refined sugars and saturated fats, and focus on nutrient-dense foods like leafy greens, whole grains, and lean proteins. We’re talking foods like collard greens, black-eyed peas, or grilled fish, which is great for the heart. Diets rich in plants, such as vegetable stews or lentil-based recipes, have also been shown to significantly reduce epicardial fat.

Finally, don’t forget stress issues. If you’re chronically on edge, epicardial fat can increase dramatically. This is why mindfulness practices, yoga, and meditation can help so significantly. Research indicates that just eight weeks of mindfulness-based stress reduction can lower epicardial fat noticeably in high-stress individuals.

So, in review, it’s critical that you keep an eye on things. If you have heart disease risk factors or related conditions, you may be at high risk. In these cases, don’t shy away from testing, and try to join local fitness groups or online communities to stay motivated. If you can’t access good nutrition where you live, look into farmers’ markets, community gardens, and programs like SNAP for affordable produce.

And as always, monitor your progress. You can track metrics like waist circumference or energy levels to gauge improvement, but for the best understanding, don’t neglect accurate imaging.

By taking simple, commonsense steps, you’ll be feeling better and living healthier before you know it!

By Evan Bollinger | Published July 7, 2025