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Having high pericardial fat volume—fat around your heart—can increase your risk of heart failure regardless of your bodyweight, a 2021 study suggests.
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More than 6 million people in the U.S. are impacted by heart failure, a condition in which the heart can’t pump enough blood for the body’s needs.
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To reduce the risk of excess pericardial fat, experts recommend working toward habits that contribute to better heart health overall.
Research from Mount Sinai in New York previously revealed a high risk factor for heart failure that most of us may be unaware of: Pericardial fat. Regardless of overall body weight, pericardial fat (the fat that surrounds your heart) may be strongly correlated to heart failure.
For the study, which was published in 2021 in the Journal of the American College of Cardiology, researchers used CT scans to determine the connection between pericardial fat volume and newly diagnosed heart failure, a condition in which the heart can’t pump the amount of blood the body needs to function. More than 6 million people in the U.S. have heart failure, which a person can develop suddenly or over time.
Meet the experts: Danielle Belardo, M.D., a preventive cardiologist based in Los Angeles and member of MyFitnessPal’s Scientific Advisory Council; and Satish Kenchaiah, M.D., associate professor of medicine and cardiology specialist at the Icahn School of Medicine at Mount Sinai
The CT scans were sourced from the Multi-Ethnic Study of Atherosclerosis sponsored by the National Heart, Lung, and Blood Institute, and included scans from 6,785 men and women between the ages of 45 and 84 without pre-existing cardiovascular disease.
What did the study find?
The researchers found that, even though women typically had less pericardial fat than men, women who did meet the criteria for high pericardial fat volume (70 cubic centimeters or more) had double the risk of developing heart failure. Men who met the fatty heart criteria (120 cubic centimeters or more) had a 53% increased risk.
What’s more, a higher amount of pericardial fat was dangerous regardless of the participants’ body weight. That means being thin didn’t necessarily prevent harmful fat build-up around the heart.
The researchers also adjusted for other well-known risk factors for heart failure such as age, tobacco use, alcohol consumption, a sedentary lifestyle, high blood pressure, high cholesterol, and previous heart attacks. Results were similar across all racial backgrounds.
“Pericardial fat is a specific type of fat that sits around the heart, particularly between the outer layers of the pericardium (the sac that encases the heart). It includes both epicardial fat (directly on the heart’s surface) and paracardial fat (just outside the pericardium). Pericardial fat is metabolically active, meaning it doesn’t just sit there. It secretes inflammatory substances, such as cytokines, that can directly affect the heart muscle and nearby coronary arteries,” explains Danielle Belardo, M.D., a preventive cardiologist based in Los Angeles and member of MyFitnessPal’s Scientific Advisory Council. “Essentially, this type of fat is a marker, and possibly a driver, of cardiometabolic disease.”
When there is extra fat surrounding your heart, fatty droplets may begin to accumulate within the heart muscle cells, says lead study author Satish Kenchaiah, M.D., associate professor of medicine and cardiology specialist at the Icahn School of Medicine at Mount Sinai. These droplets can interfere with how your heart chamber expands and reduce your heart’s ability to pump blood properly, setting the stage for heart failure, he says.
A fatty heart is also related to plaque buildup in the coronary arteries that supply blood to the heart muscles. This is a known risk factor for heart attacks, which could subsequently increase the risk of developing heart failure down the line, he adds.
While the study was published in 2021, Dr. Belardo says it is “highly relevant today,” adding that the findings are large, ethnically diverse, robust, and methodologically sound. The data “reflects trends that are only intensifying in 2025 with rising rates of obesity, type 2 diabetes, and metabolic dysfunction,” Dr. Belardo adds. “These findings underscore the importance of going beyond traditional metrics like BMI and focusing on regional fat depots that exert direct pathophysiological effects on the heart.”
How to reduce pericardial fat
Dr. Kenchaiah says more research is needed to determine how to reduce and prevent excess pericardial fat, but working toward habits that contribute to better heart health overall is a good place to start. To keep your ticker in tip-top shape, he recommends the following:
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Eat a Mediterranean-style diet, which is rich in colorful fruits and vegetables, fiber-rich whole grains and legumes, olive oil, nuts and seeds, and lean proteins like seafood and poultry.
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Aim for 75 minutes of heart-pumping exercise (such as running) or 150 minutes of moderate activity (like brisk walking) throughout the week.
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Avoid excessive alcohol intake, which is considered no more than one drink per day for women and two for men.
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Work with your doctor to lower high blood pressure, high blood sugar, or high cholesterol levels—all of which increase your risk of heart disease.
When to see your doctor
“Pericardial fat itself does not cause symptoms. It acts as an inflammatory organ that increases risk for heart failure, coronary artery disease, and arrhythmias,” Dr. Belardo says. Symptoms of heart failure, which may develop over time in people with high pericardial fat, include:
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Shortness of breath with activity or lying flat
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Fatigue or reduced exercise tolerance
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Leg swelling
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Rapid weight gain from fluid
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Persistent cough or wheezing
If you have any of the above symptoms, have obesity, prediabetes, diabetes, high cholesterol, hypertension, or metabolic syndrome, or have a family history of heart failure or early cardiovascular disease, Dr. Belardo says you should see your doctor. “Cardiac imaging, blood tests, and early preventive care can be crucial for catching heart disease before symptoms develop,” she explains.
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