Studies done at the University of Pittsburg Schools of the Health Sciences have pinpointed a type of heart fat, linked to a risk for heart disease and shown that menopausal status and estrogen levels are critical modifying factors of its associated risk in women.

According to the researchers it is a higher volume of a certain type of fat that surrounds the heart is significantly associated with a higher risk of heart disease in women after menopause and women with lower levels of estrogen at midlife, according to new research led by the University of Pittsburgh Graduate School of Public Health.


There are two types of fat surrounding the heart:

  • Epicardial fat, the fat that directly covers the heart tissue (the myocardium) and is located between the outside of the heart and the pericardium (the membrane that encases the heart). It is the energy sources for the heart.
  • Paracardial fat, which is outside of the pericardium, anterior to the epicardial fat. There are no known heart-protective function of this fat.

El Khoudary and her team evaluated clinical data, including blood samples and heart CT scans, on 478 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women were in varying stages of menopause, averaged 51 years old and were not on hormone replacement therapy.

In a previous study, the team showed that a greater volume of paracartial fat, but not epicardial fat, after menopause is explained by a decline in the sex hormone estradiol, which is the most potent estrogen in women. The higher volume of epicardial fat was tied to other risk factors, such as obesity.

In a new study, the researchers build on those findings to discover that not only is a greater paracardial fat volume specific to menopause, but in postmenopausal women and women with lower levels of estradiol. It is also associated with a greater risk of coronary artery calcification, an early sign of heart disease that is measured with a heart CT scan.

El Khoudary is planning a study to evaluate hormone replacement therapy on heart fat accumulation, paying particular attention to the types of heart fat.

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