Obesity and endothelial function

Purpose of review The growing prevalence of diabetes and coronary artery disease (CAD) parallels the increased prevalence of obesity. This review explains the pathogenic role of excessive fat accumulation, especially the visceral fat in altering endothelial function. It clarifies the link between adipose tissue function, insulin resistance, and vascular reactivity. In addition, it demonstrates the role of lifestyle modification in improving endothelial function in obese individuals. Recent findings We demonstrated our most recent understanding of the pathogenesis of endothelial dysfunction as an initial step in the atherosclerotic process, and how inflammation plays a major important role in its development. The emerging hypothesis that increased secretion of adipokines by adipose tissue, particularly visceral adipocytes, are responsible for initiating subclinical inflammatory status that contribute to the development of both insulin resistance and endothelial dysfunction are covered. We also reviewed several recent studies that showed the effect of weight reduction by diet restriction, increased physical activity, medications, or surgical intervention in changing insulin sensitivity and endothelial function. Summary Better understanding of the link between obesity and endothelial function may help clinicians to build a comprehensive strategy aiming at reducing the cardiovascular mortality among type 2 diabetic patients through lifestyle modification with or without medications. It will also serve as background to further research projects aiming at selective reduction of adipose tissues burden by identifying the modifiable and the nonmodifiable targets.