Regulation of visceral and epicardial adipose tissue for preventing cardiovascular injuries associated to obesity and diabetes.
Regulation of visceral and epicardial adipose tissue for preventing cardiovascular injuries associated to obesity and diabetes.
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DOI：
10.1186/s12933-017-0528-4
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发表时间：
2017-04-04
影响因子：
9.3
通讯作者：
Lorenzo Ó
中科院分区：
文献类型：
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作者：
González N;Moreno-Villegas Z;González-Bris A;Egido J;Lorenzo Ó
目前，肥胖在全球大多数人群中呈严重上升趋势，并与2型糖尿病(T2 DM)等高死亡率疾病及其随后的心血管病变的发生和发展有关。最近的数据表明，在肥胖症患者中，体脂分布和脂肪细胞表型比一般肥胖症的增加更能决定患者的死亡结果。特别是，内脏肥胖症与不同心脏结构的长期变化密切相关，在高血压和缺血性心脏病以及糖尿病心肌病等发展中的心肌疾病中也是如此。有趣的是，这个储存库也可能与心外膜脂肪堆积有关，它通过分泌脂肪、脂肪因子以及脂肪细胞的促炎和氧化因子来实现。因此，内脏肥胖及其白色单脂样脂细胞是不同形式心脏病和心力衰竭的危险因素，主要是在较高程度的肥胖者中。然而，在特定的刺激下，这些脂肪细胞中的一些可以转化为具有抗炎和抗凋亡特性的棕色多线粒体样脂肪细胞。因此，为了改善肥胖和T2 DM患者潜在的心血管异常，已经提出了几种治疗策略来调节内脏和心外膜脂肪体积和表型。除了改变生活方式外，在脂肪组织中进行特定的基因操作，以及使用PPARγ激动剂或他汀类药物，都可以改善脂肪体积和表型，并减少心血管衰竭。此外，胰岛素刺激减少了内脏和心外膜脂肪厚度，而增加了棕色脂肪细胞的形成，缓解了胰岛素抵抗和相关的心血管病理。
Nowadays, obesity is seriously increasing in most of the populations all over the world, and is associated with the development and progression of high-mortality diseases such as type-2 diabetes mellitus (T2DM) and its subsequent cardiovascular pathologies. Recent data suggest that both body fat distribution and adipocyte phenotype, can be more determinant for fatal outcomes in obese patients than increased general adiposity. In particular, visceral adiposity is significantly linked to long term alterations on different cardiac structures, and in developed forms of myocardial diseases such as hypertensive and ischaemic heart diseases, and diabetic cardiomyopathy. Interestingly, this depot may be also related to epicardial fat accumulation through secretion of lipids, adipokines, and pro-inflammatory and oxidative factors from adipocytes. Thus, visceral adiposity and its white single-lipid-like adipocytes, are risk factors for different forms of heart disease and heart failure, mainly in higher degree obese subjects. However, under specific stimuli, some of these adipocytes can transdifferentiate to brown multi-mitochondrial-like adipocytes with anti-inflammatory and anti-apoptotic proprieties. Accordingly, in order to improve potential cardiovascular abnormalities in obese and T2DM patients, several therapeutic strategies have been addressed to modulate the visceral and epicardial fat volume and phenotypes. In addition to lifestyle modifications, specific genetic manipulations in adipose tissue and administration of PPARγ agonists or statins, have improved fat volume and phenotype, and cardiovascular failures. Furthermore, incretin stimulation reduced visceral and epicardial fat thickness whereas increased formation of brown adipocytes, alleviating insulin resistance and associated cardiovascular pathologies.