Published online before print February 15, 2007, doi: 10.1161/ATVBAHA.106.131755
© 2007 American Heart Association, Inc.
Brief Reviews |
Adipose Tissue and Atherosclerosis
Exploring the Connection
From the Departments of Human Nutrition (G.F., T.M.), Medicine (T.M.), and Pharmacology (T.M.), University of Illinois at Chicago.
Correspondence to Theodore Mazzone, MD, Section of Endocrinology, Diabetes & Metabolism, University of Illinois at Chicago, 1819 W Polk St (M/C 797), Chicago, IL 60612. E-mail tmazzone{at}uic.edu
The prevalence of obesity, especially among the young, is dramatically increasing in the United States. Obesity is associated with accelerated atherosclerosis and increased rates of cardiovascular death. There are many plausible mechanisms by which an increase in adipose tissue could adversely affect the vessel wall. These include the changes in blood pressure, glucose level, lipid/lipoprotein metabolism, and systemic inflammation. In addition, factors secreted by adipose tissue may directly influence vessel wall homeostasis by influencing the function of endothelial cells, arterial smooth muscle cells, and macrophages in the vessel wall. There is general agreement that central, as opposed to peripheral, adipose tissue confers the most cardio-metabolic risk. Although the basis of this differential risk has not been not established, the pattern of gene expression and secretory products in visceral fat would be predicted to be more atherogenic compared with that in subcutaneous peripheral fat. Numerous studies have shown the beneficial effects of weight loss on markers of cardiovascular risk but fewer have demonstrated improvement in direct measures of large vessel disease. The unfolding role of adipose tissue as an important metabolic and secretory organ provides new opportunities for developing more effective approaches for preventing obesity and its atherosclerotic complications.
The increasing prevalence of obesity in the United States will have a direct impact on atherosclerosis and subsequent rates of cardiovascular disease. This article considers potential mechanisms for the adverse effect of excess adipose tissue on the vessel wall, the importance of different adipose tissue depots, and the evidence that reduction of adipose tissue can reverse atherosclerosis risk.
Key Words: obesity • atherosclerosis • adipocytokines • lipoprotein metabolism • visceral fat
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