Pontificia Universidad Católica de Chile: The cardiac paradox: when being thin does not necessarily mean having a healthy heart

How do you know if your heart is healthy? Sometimes it is not enough to know that a person is thin to believe that they have good heart health. The adipose tissue that lodges in the outer walls of this muscle could affect people who on the outside look “healthy. A newly published research conducted this analysis and found surprising findings that could break the paradigm of the “healthy inside and out” person.

A recent study, conducted by a group of universities and hospitals in the United States, affirms the existence of a direct relationship between the volume of adipose tissue in the heart and the risks of having a heart failure. The interesting thing is that this fat would not only be found in overweight or obese people, but would be present in thin people, and even in high-performance athletes.

The cardiologist and researcher at the Millennium Nucleus in Cardiovascular Magnetic Resonance (Núcleo Cardio MR), Gonzalo Martínez, explains that this layer of fat is housed between the outer cardiovascular wall and a tissue that covers the entire muscle, called “pericardium.”

But what is its function? The alternate director of the Núcleo Milenio Cardio MR, Marcelo Andía , points out that “it fulfills a role of mechanical protection against the friction produced by the continuous movement of the heart in the thorax.” In addition, this layer also acts as a source of energy for the myocardium, through the fatty acids it contains. Its presence is normal and healthy, according to the researchers.

There is a direct relationship between the volume of fatty tissue in the heart and the risks of heart failure. The interesting thing is that this fat would not only be found in overweight or obese people, but would be present in thin people, and even in high-performance athletes


Andía also points out that human beings store fat in two different places in our body: subcutaneous deposits, which is usually considered metabolically inactive; and visceral or intra-abdominal fat, which is considered metabolically active, pro-inflammatory and highly associated with heart disease.

From multiple studies it is known that the amount of visceral fat is associated with an increased risk of having diseases such as atherosclerosis and complications such as heart attacks. But the adipose tissue lodged in the heart is not of the same nature as that present in the abdominal cavity.

But then, why pay attention to this fatty tissue in the pericardium, which does not seem as harmful as you think? According to academic Gonzalo Martínez, who is also part of the Faculty of Medicine of the Pontifical Catholic University, “it has been seen that this adipose tissue has a capacity for inflammation. This, as detailed, seems to be that it can activate certain inadequate responses in the coronary arteries, which are responsible for causing heart attacks.

“We must not fool ourselves”
“Pericardial fat exists in all individuals, but it can vary in its magnitude”, complements Martínez. In ancient descriptions a disease called ‘Adiposis Cordis’ was described, which indicated a large amount of fat in the walls of the heart. This was related to morbidly obese patients. However, at present, this phenomenon is more associated with the degree of inflammation that this adipose layer may have.

In short, pericardial adipose tissue is not harmful on its own. Its ability to become inflamed and cause problems in the coronary arteries is related to the amount of visceral fat that may be lodged in the individual’s abdominal cavity. However, this is not exclusive to people who are overweight or obese.

Sedentary people with poor eating habits, whether overweight or normal weight, will tend to have a higher risk of accumulating fat inside the abdomen.

“We must not fool ourselves, as there are people who appear thin but may have large volumes of visceral or intra-abdominal fat that is not visible to the eye. And on the contrary, people who are obviously overweight, such as Japanese sumo wrestlers for example, where the predominance is subcutaneous fat.

In general, we can say that sedentary people with poor eating habits, whether overweight or normal weight, will tend to have a greater risk of accumulating fat inside the abdomen.

This, according to the researchers, is particularly more common in men and women after menopause . The risks of heart failure are increased in these cases, which could trigger a failure caused silently in those who look healthy on the outside, and are not healthy on the inside.

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