Endothelial dysfunction associated with obesity and the effect of weight loss interventions

Abstract

Endothelial damage is central to the initiation and progression of atherosclerosis, while in addition vascular endothelial cells secrete several anti-atherogenic substances including the potent vasodilator nitric oxide. Increased adhesion molecule expression, in response to pathophysiological stimuli is perhaps the earliest indicator of compromised endothelial integrity. Obesity and adiposity are associated with an increased risk of CVD, influencing disease progression via a number of mechanisms, including enhanced endothelial activation. This review discusses possible mechanisms linking adiposity and more specifically regional fat depots with endothelial function and evaluates studies investigating the effect of weight loss on endothelial function, assessed by biochemical and physiological measurements. Overall, the research to date suggests that visceral adiposity is a stronger predictor of endothelial activation than overall adiposity, possibly mediated via the action of NEFA in circulation. While in general there is a suggestion that weight loss is associated with significant improvements in endothelial function, this is not apparent in all interventions and published literature to date provides less than convincing evidence for the effects of weight loss on endothelial activation.

Palmolein and olive oil consumed within a high protein test meal have similar effects on postprandial endothelial function in overweight and obese men: A randomized controlled trial

“…Overweight and obesity is associated with endothelial dysfunction [15] and it was therefore considered important to establish the effects of the interventions being tested in this population. Women were excluded to remove the potential confounding effects of the menstrual cycle on FMD [7].…”

“…Thus, it remains unclear whether this FMD difference of 2% is relevant under postprandial conditions. Further strengths were that overweight or obese men were studied, representing an important and relevant target group at increased risk of endothelial dysfunction [15]; and the effects were investigated in the context of a typically consumed meal (containing whole foods, namely chicken, bread and salad) that Table 4 Mean (95% CI) a changes in biochemical markers of endothelial function and oxidative stress following test meals containing olive oil or palmolein (n ¼ 28 achieve greater relevance to typical postprandial conditions. However, the effects of these oil sources on vascular function may be different in the context of a low protein meal.…”

“…The aim of this study was to assess postprandial effects of typical meals high in protein containing either palmolein or olive oil on endothelial function in overweight or obese men, a target group with high prevalence globally [14] with increased risk of endothelial dysfunction [15]. We hypothesized that palmolein relative to olive oil, in the context of a high protein meal, will have similar effects on endothelial function as assessed by FMD as primary outcome.…”

Effects of Bariatric Surgery on Human Small Artery Function

“…Small artery disease is also common in obesity and contributes to the development of hypertension and microvascular disease due to changes in peripheral resistance and local autoregulation (4). Historically, the small artery dysfunction in obesity has been attributed to damage to the endothelium (5), most notably to generation and release of nitric oxide (NO) (6). More recently, however, appreciation has grown for an additional mechanism by which vascular damage occurs in obesity; the function of fat surrounding arteries, or perivascular adipose tissue (PVAT).…”

Association of ambulatory heart rate and atherosclerosis risk factors with blood pressure in young non-hypertensive adults

“…17 Endothelial dysfunction is central to the initiation and progression of atherosclerosis, since vascular endothelial cells secrete several antiatherogenic substances including the potent vasodilator nitric oxide. 18 Overall, research to date suggests that visceral adiposity is a stronger predictor of endothelial activation than overall adiposity. Insulin resistance is associated with systemic coronary artery disease risk factors, including adiposity; increasing evidence suggests that defective insulin signalling in atherosclerotic lesional cells also contributes to disease progression.…”