What Fat Around the Heart Might Mean For Women's Health Risks

You may already know that fat around your midsection—aka visceral fat—is more dangerous than fat stored elsewhere in the body. That's because it surrounds your organs and releases compounds that contribute to inflammation. That same type of visceral fat can also accumulate around the heart, which may be even more harmful, particularly in women.

Women with high amounts of fat here—sometimes referred to as fatty heart or pericardial fat—are twice as likely to have heart failure as those with average amounts, according to a large 2021 study in the Journal of the American College of Cardiology. Men with pericardial fat are also at an increased risk but to a lesser extent (only 50 percent more likely).

How Is Fatty Heart Diagnosed?

Excess fat surrounding the heart is a dangerous but hard-to-detect condition. In addition to heart failure, it has also been linked more generally to cardiovascular disease. It cannot be seen by observation or a standard physical exam. The best way to diagnose it is with a CT scan, which is expensive and exposes patients to small amounts of radiation.

Who Is at Risk?

Obesity and excess weight are linked to excess fat around the heart, and researchers have tried to pin down other factors that might help healthcare providers screen for it.

Some research has suggested that some easy-to-identify characteristics—like age, body composition, and shape—may help indicate whether women were at high risk of fatty heart and related heart disease.

In a 2018 study in the journal Menopause, University of Pittsburgh researchers analyzed data from physical exams and chest scans of 524 women in varying stages of menopause. The research focused on women in mid-life (average age 51), because previous studies have suggested that women tend to accumulate more cardiovascular fat later in life. The link between fatty heart and cardiovascular disease risk also seems to be stronger after menopause.

The researchers adjusted their results to account for the potential effects of smoking, alcohol consumption, menopausal status, and socioeconomic factors. And as expected, they found that the more fat the women carried overall, the more fat they had around their hearts, as well.

Researchers also looked at possible connections between pericardial fat, cardiovascular disease, and factors like high body mass indexes (BMIs), body shape, and the proximity of the fat to the heart. The closer fat is to the organ, the more it can damage heart tissue with its inflammatory proteins, said senior author Samar El Khoudary, PhD, associate professor of epidemiology at Pitt Public Health.

The findings mirrored the results of other research done by the same authors on men and published in 2014. "This study, coupled with our previous study in men, gives doctors another tool to evaluate their patients and get a better sense of their heart disease risk," said El Khoudary. "It also may lead to suggestions for lifestyle modifications to help patients lessen that risk."

Healthcare providers don't routinely screen for fat around the heart, and more research is needed to determine the best treatment strategies, said El Khoury. And because they only looked at women's health data from one point in time, the authors note that they could not determine how changes in BMI or waist circumference might affect levels of fat around the heart.

Lifestyle and Nutrition Help Reduce the Risk

The authors of both studies stress the importance of eating healthy and staying active in minimizing cardiovascular risk. Maintaining a healthy weight overall may protect the heart from harmful fat accumulation, especially after menopause, El Khoudary said. "I want to emphasize the importance of following a healthy lifestyle, making sure people exercise and eat right," El Khoudary said. "The more we emphasize this, the more we are able to achieve a healthy weight and better health."