Impact of the metabolic syndrome on subcutaneous microcirculation in obese patients

Grassı, Guıdo; Seravalle, Gino; Brambilla, Gianmaria; Facchetti, Rita; Bolla, G.; Mozzi, Enrico; Mancia, Giuseppe

doi:10.1097/hjh.0b013e32833af3c9

Cited by 32 publications

(50 citation statements)

References 39 publications

(91 reference statements)

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“…This suggested the presence of an impairment of NO-related endothelial function in the microvasculature in accordance with previous studies in skin and abdominal subcutaneous microcirculation. 14,16 Moreover, a strong correlation was previously reported from an investigation into the endothelial function of the skin microcirculation in response to ACh iontophoresis and the brachial arterial endothelial reactivity assessed by FMD, in a nonselected population. 24 We observed a more modest correlation (r=0.51; P<0.001), which could be explained by our well-phenotyped MetS participants.…”

Section: Discussionmentioning

confidence: 70%

“…12,13 More comprehensive studies have also observed endothelium-dependent dysfunction at a cutaneous 5,14,15 and subcutaneous levels. 16 However, only 1 study 14 has also reported smooth muscle cell dysfunction in the skin microcirculation. What remains unknown is whether the presence of diabetes mellitus is a confounder in microand macrovascular dysfunction of individuals with MetS.…”

mentioning

confidence: 99%

“…17 The link could explain, at least in part, macro-and microcirculatory impairments reported in this population in cutaneous and in subcutaneous vascular beds. 5,[12][13][14]16 Nevertheless, to the best of our knowledge, whether abdominal obesity and inflammation are associated with both macro-and microcirculation NO-related pathway in patients with MetS remains unknown.…”

mentioning

confidence: 99%

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Metabolic Syndrome Individuals With and Without Type 2 Diabetes Mellitus Present Generalized Vascular Dysfunction

Walther

Obert

Dutheil

et al. 2015

ATVB

108

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Objectives— The first objective of this study was to demonstrate differences within endothelial-dependent and endothelial-independent vasoreactivity in macro- and microcirculation beds among patients with metabolic syndrome (MetS) with and without type 2 diabetes mellitus (T2D) compared with healthy counterparts. The second objective was to determine relationships among the function of macro- and microvascular systems and abdominal adiposity, as well as inflammatory markers in the 3 groups. Approach and Results— Cross-sectional analyses of 53 patients with MetS without T2D and 25 with T2D, as well as aged 40 years and sex-matched healthy controls included microvascular (cutaneous blood flow measured with laser Doppler flowmetry in response to iontophoresis of acetylcholine and sodium nitroprusside), and macrovascular reactivity (flow-mediated dilation and nitrate-mediated dilation) along with anthropometric measures, plasma glucose, and insulin and inflammatory markers. Compared with controls, MetS participants showed depressed endothelial function of both micro- and macrocirculation beds. T2D in patients with MetS revealed an exacerbated vascular smooth muscle dysfunction in micro- and macrocirculation compared with MetS without T2D. Indices of micro- and macrocirculation were predominantly inversely related to abdominal fat and inflammatory markers. Conclusions— MetS was associated with endothelial-dependent and endothelial-independent dysfunction, affecting both the macro- and the microvascular systems. Participants with diabetes mellitus demonstrated the most severe smooth muscle dysfunction. The presence of central abdominal fat and systemic inflammation seems implicated in the pathogenesis of vascular dysfunctions in MetS.

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Section: Discussionmentioning

confidence: 70%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Metabolic Syndrome Individuals With and Without Type 2 Diabetes Mellitus Present Generalized Vascular Dysfunction

Walther

Obert

Dutheil

et al. 2015

ATVB

108

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“…12,13 In fact, structural alterations of small arteries are associated with an increased cardiovascular risk in hypertensive and diabetic patients, perhaps as a consequence of an impaired organ flow reserve in several relevant vascular districts. 9,14,15 The presence of obesity, 21 with or without other components of the metabolic syndrome, 22 seems to be associated with hypertrophic remodeling of subcutaneous small vessels. Hypertrophic remodeling, such as that observed in diabetic or obese patients, seems to be associated with an even worse prognosis 14 compared with eutrophic remodeling.…”

Section: Discussionmentioning

confidence: 99%

“…21 The same authors confirmed these data in a population of severely obese patients with metabolic syndrome. 22 However, no data are presently available about the effect of a pronounced weight loss on the structure of small resistance arteries in obese patients.…”

mentioning

confidence: 99%

Effects of Weight Loss on Structural and Functional Alterations of Subcutaneous Small Arteries in Obese Patients

et al. 2011

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Abstract-Structural alterations of subcutaneous small resistance arteries, as indicated by an increased media:lumen ratio, are frequently present in hypertensive and/or diabetic patients and may represent the earliest alteration observed. In addition, media:lumen ratios of small arteries have a strong prognostic significance. However, no data are available about the structure of small resistance arteries of obese patients, particularly after weight loss. We have investigated 27 patients with severe obesity. Twelve of them were normotensive, and 15 were hypertensive. All of the obese patients underwent bariatric surgery. We compared results obtained with those observed in 13 normotensive lean controls and in 13 hypertensive lean patients. All of the subjects and patients underwent a biopsy of subcutaneous fat during surgical intervention. In 8 obese patients, a second biopsy was obtained after consistent weight loss, during a surgical intervention for abdominoplasty. Subcutaneous small resistance arteries were dissected and mounted on a wire myograph, and structural parameters were measured. A concentration-response curve to acetylcholine was performed to evaluate endothelial function. Obese patients, independent from the presence of hypertension, show the presence of an increased media:lumen ratio and media cross-sectional area, together with an impaired endothelial-dependent vasodilatation. After surgical correction of obesity and consistent weight loss, a significant improvement of microvascular structure and of some oxidative stress/inflammation markers were observed. In conclusion, our data suggest that the presence of obesity is associated with structural alterations of subcutaneous small resistance arteries, mainly characterized by hypertrophic remodeling. Weight loss may improve microvascular structure. (Hypertension. 2011;58:29-36.)Key Words: remodeling Ⅲ hypertension Ⅲ obesity Ⅲ microcirculation Ⅲ small arteries A lterations in the microcirculation are common accompaniments of cardiovascular and metabolic diseases 1,2 and may involve small resistance arteries, arterioles, capillaries, and postcapillary venules. 3 In particular, the structure of subcutaneous 1-3 and cerebral 4 small resistance arteries (lumen diameter: 100 to 300 m) may be altered in the presence of cardiovascular or metabolic diseases. Essential hypertension is associated with a narrowing of the internal lumen and with an increase of media wall thickness, with consequent increase in the media:lumen ratio. 1 The observed increase in the media:lumen ratio may be the consequence of an eutrophic remodeling (rearrangement of otherwise normal material around a narrowed lumen) or of a hypertrophic remodeling (vascular smooth muscle cell hypertrophy or hyperplasia). 5 Eutrophic remodeling of subcutaneous small arteries is commonly seen in essential hypertension, whereas an inward hypertrophic remodeling, with evident smooth muscle cell growth, was shown in patients with type 2 diabetes mellitus, regardless of the presence of elevated or normal ...

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Prognostic Role of Microvascular Damage and Effect of Treatment

Agabiti‐Rosei

Agabiti-Rosei

Rizzoni

2020

Updates in Hypertension and Cardiovascular Protection

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Impact of the metabolic syndrome on subcutaneous microcirculation in obese patients

Cited by 32 publications

References 39 publications

Metabolic Syndrome Individuals With and Without Type 2 Diabetes Mellitus Present Generalized Vascular Dysfunction

Metabolic Syndrome Individuals With and Without Type 2 Diabetes Mellitus Present Generalized Vascular Dysfunction

Effects of Weight Loss on Structural and Functional Alterations of Subcutaneous Small Arteries in Obese Patients

Prognostic Role of Microvascular Damage and Effect of Treatment

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