Fat surrounding the heart, and not liver fat, is associated with poorer cardiovascular disease outcomes and adverse left ventricular remodeling, according to new research in JACC: Cardiovascular Imaging.

Researchers studied 4,234 participants with MRI and CT measurements for pericardial fat volume and hepatic attenuation, a measure of liver fat. With a median follow-up of 12.2 years, they analyzed the incidence of hard atherosclerotic cardiovascular disease (ASCVD), defined as coronary heart disease, heart attack, resuscitated sudden cardiac arrest or stroke.

For each standard deviation increase in pericardial fat, patients were at a 22 percent increased risk of hard ASCVD and showed greater left ventricular mass.

Hepatic fat by CT was not associated with hard ASCVD.

“We demonstrate pericardial fat is associated with incident CVD over long-term follow-up as well as cardiac structure, independent of selected measured influences of dysfunctional adiposity, defined by cardiometabolic risk factors, insulin resistance, inflammation, and imaging surrogates of hepatic fat content,” wrote lead researcher Ravi V. Shah, MD, with Massachusetts General Hospital in Boston, and colleagues.

In addition, the authors noted trends among female and African-American participants.

“In exploratory analyses, we found complex sex- and race-based heterogeneity in cardiac structural associations with pericardial fat, including greater hypertrophy and concentric LV remodeling in women, and a nonlinear relationship between pericardial fat and LV function in African Americans,” they wrote. “While these observations arise from secondary analyses and require confirmation in larger, emerging multiethnic cohorts worldwide, they are concordant with prior laboratory and clinical research.”

Shah et al. suggested future studies to clarify whether interventions “specifically targeting pericardial fat” could reduce cardiovascular risk in the obese population.