Today, despite all the measures taken, cardiovascular diseases remain the main cause of temporary invalidization, disability and mortality. Obesity is a major risk factor of cardiovascular diseases and complications from them. However, not all fat depots have the same proinflammatory, paracrine and metabolic activity. Recent studies have shown that the accumulation of visceral fat, and not subcutaneous fat, is associated with an increase in cardiometabolic risk. At the same time, there is evidence that an increase in the area of visceral fat is a protective mechanism against lipotoxicity. The purpose of this review is to discuss current literature data reflecting the characteristics of the visceral, epicardial and perivascular fat depots, and also their association with cardiovascular diseases.
Introduction. To date, cardiovascular diseases (CVD) remain the main cause of disability and mortality in population. The majority of ectopic fat deposits demonstrated a reliable association with cardiometabolic risks and clinical manifestations of most CVD. The elucidation of the metabolic features of adipocytes of epicardial adipose tissue localized in the immediate vicinity of the lesion in ischemic heart disease (IHD) can have both theoretical and practical significance for pathophysiology and cardiology. Aim. To study the adipokine-cytokine profile of epicardial adipocytes (EA) and subcutaneous adipose tissue (SCAT), blood serum in relation to the area of visceral adipose tissue (AVAT), biochemical and rhelinic characteristics of IHD patients. Methods. 84 patients (70 men and 14 women) with IHD were examined. In the presence of visceral obesity (VO), patients were divided into two groups. In patients with VO, adipocyte EA and SCAT were sampled, followed by cultivation and evaluation of adipokine and proinflammatory activity. The parameters of carbohydrate and lipid metabolism, adipokine and proinflammatory status in blood serum were determined. Results. It has been established that the adipokine-cytokine profile of the adipocytes EA and SCAT differ. Adipocytes of EA in IHD on the background of VO are characterized by an increase in IL-1, TNF-, leptin-adiponectin ratio and a decrease in the protective factors: adiponectin and anti-inflammatory cytokine IL-10. While adipocytes of SCAT were characterized by a decrease in the concentration of the soluble receptor to leptin and a more pronounced leptin resistance, and the increase in inflammatory cytokines was compensated by an increase in the concentration of IL-10, the presence of VO was associated with multivessel coronary disease, multifocal atherosclerosis, insulin resistance, atherogenic dyslipidemia, adipokine imbalance, and markers of inflammation. Thus, the value of the area of VO determined higher values of leptin concentration, TNF- in adipocytes and serum, lipid and carbohydrate metabolism and a lower soluble receptor for leptin content. The conclusion. Thus, in IHD with VO the state of adipocytes, EA is characterized as "metabolic inflammation" and may indicate the direct involvement of adipocytes in the pathogenesis of IHD due to the formation of adipokine imbalance and the activation of proinflammatory reactions.
Aim. To determine the dependence of adiponectin gene expression by subcutaneous, epicardial and perivascular adipocytes on the degree of coronary lesion in coronary heart disease. Materials and methods. 84 patients with coronary artery disease were examined. Of these, 39 people showed a moderate degree of atherosclerotic lesion of the coronary bed (less than or equal to 22 points) on the SYNTAX Score scale, 20 severe (2231 points), and 25 extremely severe (more than 32 points). Upon admission to the hospital, all patients underwent an echocardiographic study (Echocardiography, Acuson, Germany) with the calculation of the ejection fraction (EF) of the left ventricle (LV) to assess its systolic function. During a planned surgical intervention (coronary bypass surgery, CABG), adipocytes of subcutaneous, epicardial (EAT) and perivascular adipose tissue (PVAT) were taken. Adiponectin gene expression was evaluated by polymerase chain reaction (real-time PCR) using TaqMan probes. Statistical analysis was performed using Statistica 9.0. Results. The maximum level of adiponectin expression was detected in adipocytes of PVAT, and the minimum EAT. With an increase in the degree of atherosclerotic lesion of the coronary bed, the expression of the adiponectin gene in adipocytes of local depots significantly decreases r=-0.82; p=0.023. Moreover, the low level of gene expression in EAT correlated with a decrease in LV EF by r=0.73; p=0.03. In adipocytes of subcutaneous and especially PVAT, gene expression was the highest in patients with a moderate degree of coronary lesion. Conclusions. Low adiponectin gene expression in EAT is associated with an increase in the degree of atherosclerotic lesion of the coronary bed and a decrease in LV EF.
Обоснование. Развитие сердечно-сосудистых осложнений у пациентов с диффузно-токсическим зобом (ДТЗ) является актуальной проблемой тиреоидологии. До настоящего времени остается открытым вопрос о роли дефицита цинка в фор-мировании осложнений со стороны сердечно-сосудистой системы (ССС) у больных с ДТЗ. Цель. Оценить вклад дефицита цинка в формирование сердечно-сосудистых осложнений у больных с ДТЗ. Методы. В исследование включено 113 женщин 25-60 лет с диагнозом ДТЗ: 54,0% (n = 61) со средней степенью тяжести тиреотоксикоза, 46,0% (n = 52) -с тяжелой. Длительность заболевания -1-5 лет. В контрольную группу вошли 37 жен-щин 25-60 лет без патологии щитовидной железы и ССС. У всех пациентов оценены: в крови -уровень тиреотропного гормона, свободного тироксина, концентрация антител к рецептору тиреотропного гормона; в волосах -концентрация цинка; результаты ультразвукового исследования щитовидной железы, эхокардиография, суточное мониторирование электрокардиографии. Результаты. При ДТЗ дефицит цинка в волосах наблюдался у 66,4% (n = 75), в группе контроля -у 27,0% (n = 10) паци-ентов (р = 0,01). Чаще дефицит цинка встречался при тяжелой степени ДТЗ -в 82,7% (n = 43), при фибрилляции пред-сердий (ФП) -в 77,4% (n = 24) случаев, при хронической сердечной недостаточности (ХСН) -в 78,8% (n = 41) случаев. Разработана с помощью логистической регрессии диагностическая модель и таблица факторов риска ХСН в баллах, включающая определение уровня цинка в волосах. Таблицу целесообразно использовать всем больным с ДТЗ для опре-деления степени риска ХСН, при среднем и высоком риске развития ХСН в схему лечения ДТЗ показано включать пре-параты цинка. Заключение. Полученные данные позволяют считать, что дефицит цинка повышает вероятность развития ФП и ХСН у больных с ДТЗ тяжелой степени тяжести, нуждается в диагностике и коррекции. Клю че вые сло ва: цинк, диффузно-токсический зоб, фибрилляция предсердий, хроническая сердечная недостаточность.Backgraund. The development of cardiovascular complications in patients with diffuse-toxic goiter (DTZ) is an actual problem of thyroidology. (SSS) in patients with DTZ. Aims. To assess the contribution of zinc deficiency in the formation of cardiovascular complications in patients with Graves' disease. Methods. The study included 113 women aged 25-60 years with the diagnosis of DTZ: 54.0% (n = 61) with an average severity of thyrotoxicosis, 46.0% (n = 52) with severe. Duration of the disease is 1-5 years. The control group consisted of 37 women aged 25-60 years without pathology of the thyroid gland and CCC. All patients were evaluated: in the blood -the level of thyroid-stimulating hormone (TTG), free thyroxine (over T4), the concentration of antibodies to the thyroid-stimulating hormone receptor (AT to RTTG); in the hair -the concentration of zinc; ultrasound (ultrasound) of the thyroid gland, echocardiography (EchoCG), daily monitoring of electrocardiography (CM ECG). Results. At DTZ deficiency of zinc in hair was observed in 66.4% (n = 75), in the control group -in 27.0% (n = 10) patients (...
Background. In coronary artery disease, a change in the adipocytokine content of local fat depots of the heart is observed. However, it has not yet been established whether the expression levels of the studied parameters are really related to the degree of atherosclerotic lesion of the spacecraft. Aims to identify the features of the expression of adiponectin, leptin and IL-6 by adipocytes of epicardial, perivascular and subcutaneous adipose tissue depending on the degree of atherosclerotic lesion of the coronary channel in coronary heart disease. Materials and methods. The study conducted at the Research Institute for Complex Issues of Cardiovascular Disease in 20172020, included 84 patients with coronary heart disease (CAD), of which 39 with a moderate degree of atherosclerotic lesion of the coronary artery (CA) ( 22 points on the SYNTAX Score scale), 20 with severe (2331 points) and 25 with extremely severe ( 32 points). Biopsies of subcutaneous (SAT), epicardial (EAT) and perivascular adipose tissue (PVAT) were obtained during elective coronary artery bypass grafting (CABG). The expression of adipocytokine genes was determined using polymerase chain reaction (real-time PCR) using TaqMan probes and the concentration of the studied adipocytokines in adipocyte culture medium by enzyme immunoassay. Statistical analysis was performed using Statistica 9.0, a one-dimensional and multi-dimensional logistic regression analysis. Results. In CAD in adipocytes of the cardiac fat depot, a shift in the balance of adipocytokines is observed towards increased expression and secretion of leptin, IL-6 and a decrease in adiponectin with maximum manifestation in severe and extremely severe coronary lesions. Adipocytes of EAT were characterized by the minimal expression of the adiponectin gene against the background of the maximum leptin and IL-6 in comparison with adipocytes SAT and PVAT. Conclusions. Low expression of the adiponectin in EAT and PVAT against the background of increased expression of leptin and IL-6 is associated with an increase in the degree of atherosclerotic lesion of the coronary channel.
This review is devoted to the analysis of data on the effect of inhibitors of 3-hydroxy-3-methylglutaryl coenzymate-reductase on the endocrine function of adipose tissue in obesity. Violation of metabolism of adipose tissue, as well as the amount of fat, are a a key factor in the pathophysiology of obesity and the development of concomitant diseases. Statins are competitive inhibitors of 3-hydroxy-3-methylglutaryl-kofermenta reductase (HMG-COA reductase) that catalyze the initial stage of cholesterol biosynthesis in the liver. Therefore, traditionally, the liver is considered as the main target organ for statins. The results of studies of molecular mechanisms of action of statins on carbohydrate and lipid metabolism, adipokine and inflammatory balance in adipose tissue on the example of isolated adipocytes (in vivo) and in living organism (in vitro) are presented. Effect of statins on the action of insulin, as well as the possibility of developing pathological conditions associated with insulin resistance and the development of type 2 diabetes mellitus (DM 2). The proven clinical effects of cholesterol-lowering action of statins, allow new insights and to further explore their possible impact on other links in the development of obesity, and potentially to use them as therapeutic agents for pharmacological correction of obesity and the fight against cardiovascular diseases.
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