Fluctuations of epicardial adipose tissue and cardiovascular health: A useful biomarker? A comprehensive review.

Epicardial adipose tissue (EAT) is a fat layer of the heart located between the pericardium and myocardium and considered to be an important fat depot of the heart bearing thermoregulatory and protective functions, amongst others. Understanding of the dynamics of EAT, both positive and negative, opens new avenues for future cardiovascular research, including the development of new diagnostic and therapeutic tools. The aim of the study was to conduct a comprehensive literature review on the role of EAT, the factors influencing the change of its size, and to learn a causative relationship between fluctuations of EAT and different physiological and pathological conditions. Overall, 516 human studies indexed in PubMed, Embase, and Cochrane Library search engines (from inception up to January 2025) were screened. A total of 467 articles were excluded because they did not meet the inclusion criteria. Finally, 44 articles published from inception until January 2025 were reviewed. Our review categorises these factors into modifiable and non-modifiable, as well as aggravating and mitigating groups, to better understand their impact on EAT and cardiovascular health. Fluctuations of EAT may potentially represent a biomarker in cardiovascular research and medicine, however, it requires further validation in future studies. In such studies, it is advisable that the influencing factors are taken into consideration with adjusted normal reference ranges of EAT. Besides, the role of modifiable factors in coronary artery disease should be studied in future trials, which may shed light on the applicability of EAT as a biomarker and improve therapeutic modalities in heart disease.