Elsevier

Atherosclerosis

Volume 233, Issue 1, March 2014, Pages 104-112
Atherosclerosis

Review
Visceral adipose tissue as a source of inflammation and promoter of atherosclerosis

https://doi.org/10.1016/j.atherosclerosis.2013.12.023Get rights and content

Abstract

The current epidemic of obesity with the associated increasing incidence of insulin resistance, diabetes mellitus and atherosclerosis affecting a large proportion of the North American and Western populations, has generated a strong interest in the potential role of visceral adipose tissue in the development of atherosclerosis and its complications. The intra-abdominal and epicardial space are two compartments that contain visceral adipose tissue with a similar embryological origin. These visceral fats are highly inflamed in obese patients, patients with the metabolic syndrome and in those with established coronary artery disease; additionally they are capable of secreting large quantities of pro-inflammatory cytokines and free fatty acids. There is accumulating evidence to support a direct involvement of these regional adipose tissue deposits in the development of atherosclerosis and its complicating events, as will be reviewed in this article.

Section snippets

Adipose tissue – a must have to survive

Adipose tissue is a type of connective tissue that plays important physiological roles in mammals. A 70 kg reference man has an average of 15 kg of adipose tissue that corresponds to 21% of body mass. This percentage is higher in women, the elderly, and overweight subjects [1]. Not all deposits of adipose tissue in the human body are composed of the same type of fat. Human adipose tissue is classically characterized as white and brown, although more recently beige adipose tissue has also been

Adipose tissue: a friend or foe for your health?

Obesity is accompanied by several adverse health effects such as hypertension, insulin resistance, franc diabetes, dyslipidemia and subclinical inflammation, all factors leading to atherosclerosis. Although adipocytes can increase in number (hyperplasia), they mostly grow in size (hypertrophy) accumulating lipids as body weight increases. In general, obesity results in a greater increase in visceral adipose tissue than in subcutaneous fat. However, it is well known that there is a “healthy

Visceral adipose tissue classification (Figs. 1 and 2)

The radiological classification of visceral adipose tissue is performed according to the body region where fat is deposited and it includes: intrathoracic (ITAT), intraabdominal (IAAT) and intrapelvic (IPAT) adipose tissue [1]. IAAT and IPAT are usually quantified together, as intraabdominopelvic (or abdominal) adipose tissue. Abdominal adipose tissue can be distinguished further into intraperitoneal and extraperitoneal adipose tissue (Fig. 1) [1]. For the purpose of this review intraabdominal

Visceral adipose tissue and atherosclerosis

Several studies explored the association of visceral adipose tissue with atherosclerosis; investigators used different methodologies for adipose tissue quantification and measured adipose tissue volume in different body regions. In the following paragraphs we will present some of the main findings according to the region where adipose tissue was quantified. Because there are discrepancies in the adipose tissue terminology used in the literature – for example the term “pericardial” adipose

Dynamic changes of visceral adipose tissue with pharmacological and non-pharmacological interventions

Interventional and observational studies have addressed the dynamic changes of visceral adipose tissue under different conditions. Weight loss was very effective in reducing abdominal VAT [76] and slightly less efficacious in reducing EAT [77], [78]. In one study, the regression of EAT volume was accompanied by a reduction in the serum level of the pro-inflammatory CD40 ligand [75]. Bariatric surgery in morbidly obese patients restored the anti-contractile activity of perivascular adipose

Pathophysiological mechanisms

The exact mechanisms by which visceral adipose tissue predisposes to atherosclerosis development are unknown, although several plausible mechanisms may be involved in this process. Large VAT volumes have been repeatedly associated with the presence of traditional cardiovascular risk factors, such as hyperlipidemia, arterial hypertension and diabetes mellitus or impaired glucose tolerance and the presence of the metabolic syndrome [82]. The endocrine, metabolic, and inflammatory activities of

Conclusion

Visceral adipose tissues (intra-abdominal and intra-thoracic) are metabolically active and are the source of humoral and cellular inflammation in obese patients and patients with established coronary artery disease. Whether the inflammation in these tissues predisposes to the development of arterial disease or is the consequence of such process is still speculative. However, the role of cellular inflammation in particular is increasingly being recognized in other cardiovascular disease states

Acknowledgments

This work was supported in part by a grant from the Stavros Niarchos Foundation (Nikolaos Alexopoulos, MD).

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