Epicardial Adipose Tissue and cardiovascular disease: unmasking the hidden culprit

The role of Epicardial Adipose Tissue (EAT) has evolved in the latest years from a passive energy repository to a dynamic contributor in cardiovascular health. This case discusses the role of EAT in residual cardiovascular risk and the potential benefits of GLP-1 receptor agonist liraglutide in mitigating its effects. We describe the case of a 62-year-old male patient, obese, hypertensive, and with a history of ischemic heart disease, was admitted to the emergency room complaining palpitations and shortness of breath. The ECG showed atrial fibrillation with rapid ventricular response with evidence of a new-onset left bundle branch block. The echocardiogram revealed heart-rate dependent regional dyskinesias, while both echocardiogram and CT scan evidenced the presence of EAT. Intrastent restenosis in the left anterior descending artery was found and treated with percutaneous revascularization. The patient was initiated on liraglutide to address residual cardiovascular risk. Follow-up showed reduced Low-Density Lipoprotein Cholesterol (LDL-c) and High-Sensitivity C-Reactive Protein (hs-CRP) levels, as well as decreased EAT thickness and Body Mass Index (BMI). EAT’s contribution to residual cardiovascular risk underscores the need for targeted interventions and treatments. Glucagon-Like Peptide-1 Receptor Agonists (GLP-1-RA) like liraglutide offer promise in addressing this risk, representing a potential venue for therapeutic exploration.