Atherothrombotic risk in obesity

Summary

A link between obesity and coronary artery disease development has been repeatedly proposed, possibly in part due to the development of a proinflammatory and prothrombotic state in obese subjects. Adipocytes secrete numerous hormones and cytokines (adipokines) which influence gene expression and cell functions in endothelial cells, arterial smooth muscle cells, and monocytes/macrophages favouring the development of an atherosclerotic vulnerable plaque. Moreover, the release of such biologically active molecules also promotes endothelial function impairment, disturbs the haemostatic and fibrinolytic systems, and produces alterations in platelet function affecting the initiation, progression, and stabilization of thrombus formation upon atherosclerotic plaque rupture.

In this review we will discuss the patho-physiological mechanisms by which obesity contributes to increase atherothrombosis paying special attention to its effects over thrombosis.

Zusammenfassung

Wiederholt wurde ein Zusammenhang zwischen Adipositas und koronarer Herzkrankheit postuliert, der teilweise auf die Entwicklung proinflammatorischer und prothrombotischer Zustände bei adipösen Patienten zurückzuführen sein könnte. Adipozyten sezernieren zahlreiche Hormone und Zytokine (Adipokine), die die Genexpression und Zellfunktionen in Endothelzellen, glatten Muskelzellen der Arterien sowie Monozyten/Makrophagen beeinflussen, so dass die Entwicklung von instabiler atherosklerotischer Plaque begünstigt wird. Außerdem fördert die Freisetzung solcher biologisch aktiver Moleküle eine endotheliale Dysfunktion, sie beeinträchtigt hämostatische und fibrinolytische Systeme und führt zu Veränderungen der Thrombozytenfunktion mit Auswirkungen auf Einsetzen, Progression und Stabilisierung der Thrombusbildung nach atherosklerotischer Plaqueruptur.

In diesem Review werden pathophysiologischen Mechanismen diskutiert, durch die Adipositas zur Förderung von Atherothrombose beiträgt. Dabei finden Auswirkungen jenseits der Thrombose besondere Beachtung.

Keywords

Atherosclerosis - thrombosis - obesity

Schlüsselwörter

Atherosklerose - Thrombose - Fettleibigkeit

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