The relationship of endothelial dysfunction and metabolic manifestations of obesity

Introduction . Over the past three decades, the prevalence of overweight and obesity in the world has grown by almost 30–50% among adults and children. A number of metabolic and hemodynamic disorders, as well as the pathology of many organs and systems are often associated with obesity. The aim of our study was to compare the functional state of the endothelium in various variants of complicated obesity (СO). Materials and methods . The study included 66 people with СO whose average age was 47.3 ± 9.9 years, from this group 3 groups were formed depending on the complications of obesity (dyslipidemia, hypertension and impaired glucose tolerance). To assess the functional state of endothelium, we used the method of wavelet analysis of skin temperature fluctuations during cooling of the limb; endothelin-1 (ET-1), albuminuria (AC), and vascular endothelial growth factor (VEGF) were determined as markers of endothelial dysfunction. Results . The levels of VEGF, ET-1 and AC in the groups with СO did not differ significantly, however, they were significantly higher than in the comparison group. The results of the cold test revealed the absence of restoration of the amplitudes of fluctuations in skin temperature equally in all groups with CO compared with the control group (post-cold vasodilation indices (IPV) in group 1 – 0.45 (0.38–0.69, in group 2 – 0.59 (0.41–0.83), in group 3 – 0.66 (0.53–0.79), in the Control group – 0.91 (0.86–1.06), p<0.05). Correlations between biochemical and instrumental markers of endothelial dysfunction and insulin resistance indices were obtained: ET-1 correlated with insulin (r=0.49; p=0.02), HOMA index (r=0.55; p=0.01); AU value correlated with glycemia (r=0.70; p=0.02); The IVC vasoconstriction index correlated with the HOMA-IR index (r=0.62; p=0.05); The IPV-1 index decreased with increasing VEGF (r=–0.86; p=0.002) and HOMA-IR (r=–0.86; p=0.002). The IPV-2 index inversely correlated with the level of postprandial glycemia (r=–0.87; p=0.05), systolic blood pressure (r=–0.55; p=0.04), OT (r=–0.57; p=0.04) and ET-1 (r=–0.58; p=0.04). Conclusion . The unified basis of the revealed disorders in СO allows us to conclude that the factors of insulin resistance are complex: hyperglycemia, dyslipidemia, and arterial hypertension, which makes it difficult to identify the leading factor in the formation of endothelial dysfunction.