When it comes to fat, it’s not just how much you have but where it’s stored that matters. Some fat depots, like epicardial adipose tissue (EAT), intermuscular adipose tissue (IMAT), and hepatic fat, can cause lipotoxicity—a toxic overload of lipids that impacts your heart and overall health.
🔬 Systemic Lipotoxicity:
Fat stored in places it doesn’t belong—like within muscles (IMAT) or the liver (hepatic fat)—releases proinflammatory molecules and free fatty acids into the bloodstream.
This systemic inflammation stresses blood vessels, disrupts insulin signaling, and contributes to coronary microvascular dysfunction (CMD) and heart failure.
The study shows that every 1% increase in fatty muscle fraction (FMF) increases the odds of CMD by 2% and the risk of major cardiovascular events by 7%.
🔗 Local Lipotoxicity:
Fat near critical organs, like EAT around the heart, has direct local effects. It produces inflammatory signals that impair nearby coronary arteries, contributing to ischemia, plaque buildup, and weakened cardiac function.
Increased IMAT may worsen EAT's effects, creating a feedback loop of inflammation and lipotoxicity that amplifies cardiovascular risk.
💡 The Takeaway on Cardiovascular Risk:
This study highlights a novel cardiometabolic phenotype where CMD, IMAT, and EAT interact to drive heart disease risk—independently of BMI.
IMAT serves as a strong predictor of systemic and local lipotoxic effects, outpacing traditional markers like BMI and hepatic fat.
🏃♂️ What Can You Do?
Reducing IMAT and EAT through exercise, proper nutrition, and managing systemic inflammation can lower lipotoxic effects and protect your heart.
👉 It’s time to focus on body composition and fat quality, not just quantity, for a healthier future!
Souza, A.C.d.A.H., et al., Skeletal muscle adiposity, coronary microvascular dysfunction, and adverse cardiovascular outcomes. European Heart Journal, 2025.

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