TNF and obesity due to melanocortin 4 receptor deficiency: Two main theories link EFT to cardiovascular disease risk: (1) its association with visceral fat and metabolic syndrome, which encompasses well recognized risk factors such as obesity and hypertension, and (2) its effects through paracrine and endocrine activity, wherein epicardial fat releases bioactive molecules that influence cardiac morphology and function both positively such as adiponectin, adrenomedullin and omentin and negatively such as interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor (TNF)-alpha [9].