The Adipocyte, Fatty Acid Trapping, and Atherogenesis

From the Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University, Montreal, Canada (A.D.S., K.C.); Department of Medicine, Huddinge University Hospital, Huddinge, Sweden (P.A.); and The Oxford Lipid Metabolism Group, Sheikh Rashid Laboratory, The Radcliffe Infirmary, Oxford, England (L.K.M.S., K.N.F.).

Correspondence to Allan D. Sniderman, MD, Mike Rosenbloom Laboratory for Cardiovascular Research, Room H7.22, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada. E-mail asniderm@is.rvh.mcgill.ca

Key Words: ASP • adipose tissue • obesity • atherogenesis • fatty acids

	Introduction

 
Much effort has been spent to identify the factors that contribute to coronary artery disease. Not surprisingly, adipose tissue has gained little attention to date in this search because no immediate and critical links between adipocyte metabolism and atherogenesis may be evident to most people. But coronary artery disease is a public health problem only in societies with high fatty acid intakes; therefore, our purpose is to outline a hypothesis that adipose tissue dysfunction may be a very common—indeed, perhaps even the most common—cause of the dyslipoproteinemia and insulin resistance that so frequently lead to coronary disease. This complex and multifaceted syndrome has received many names, depending on the original point of interest. Amongst these names are hyperapoB,¹ familial combined hyperlipidemia,² syndrome X,³ the plurimetabolic syndrome,⁴ the visceral fat syndrome,⁵ familial dyslipidemic hypertension,⁶ the atherogenic lipoprotein phenotype,⁷ and the deadly quartet.⁸ Whether these titles are different names for the same disorder or different disorders with similar features is not clear; but it is the pathophysiology of their common features on which we will concentrate. Among the most important of these features are increased numbers of the smaller, denser LDL particles, postprandial hyperlipemia, hypertriglyceridemia, low HDL cholesterol, high fasting and postprandial fatty acid levels, and insulin resistance.

Until now, excess release of fatty acids from adipocytes caused by increased lipolysis⁹ has been the only mechanism suggested to link adipocyte dysfunction and dyslipidemia. In our opinion, although excess lipolysis may be of importance in certain situations, it is not likely to be . . . [Full Text of this Article]

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