Molecular Basis of Adipose–Cardiac Crosstalk in Cardiovascular Diseases: From Mechanisms to Therapeutic Opportunities

Cardiovascular diseases remain the leading cause of mortality worldwide and are closely associated with obesity and metabolic dysfunction. Adipose tissue is now recognized as a heterogeneous endocrine and immunometabolic organ that actively communicates with the cardiovascular system through adipokines, inflammatory mediators, metabolites, and extracellular vesicles. Under physiological conditions, adipose–cardiac crosstalk contributes to metabolic and cardiovascular homeostasis, whereas adipose tissue dysfunction promotes inflammation, fibrosis, endothelial injury, and cardiac remodeling. This review summarizes the heterogeneity of adipose depots and their secretomes, discusses the molecular mechanisms underlying adipose–cardiac communication, and highlights their contributions to atherosclerosis, heart failure, hypertension, diabetic cardiomyopathy, and atrial fibrillation. We further discuss emerging biomarkers, therapeutic strategies, and precision medicine approaches targeting the adipose–cardiac axis. Understanding depot-specific signaling networks may facilitate the development of novel diagnostic and therapeutic interventions for cardiometabolic diseases.