Zeller J, et al. - In 236 obese subjects (ø body mass index 39.8 ± 7.9 kg/m²) with a variable degree of metabolic syndrome (MetS) and in 60 healthy non-obese controls (ø body mass index 24.8 ± 3.4 kg/m²), researchers investigated if the adipo-fibrokine activin A was related to increased epicardial adipose tissue (EAT), MetS, and left ventricular diastolic dysfunction (LVDD) in severely obese subjects. They found higher activin A levels in obese vs in non-obese subjects (362 ± 124 vs 301 ± 94 pg/mL), increased with the number of MetS components, and were linked with epicardial fat thickness (EFT). Overall, findings revealed a significant association of activin A with EFT, MetS, and LVDD in severe obesity, connecting MetS-related alterations in the secretory profile of EAT to the pathogenesis of obesity-related heart disease.