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Cardiovasc Res. 2017 Jul 1;113(9):1035-1045. doi: 10.1093/cvr/cvx093.

The microcirculation: a key player in obesity-associated cardiovascular disease.

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Division of Experimental Cardiology, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Department of Biomedical Science, University of Missouri, Columbia, Missouri 65211, USA.
Turku PET Centre and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku 20520, Finland.
Division of Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.


It is increasingly recognized that obesity is a risk factor for microvascular disease, involving both structural and functional changes in the microvasculature. This review aims to describe how obesity impacts the microvasculature of a variety of tissues, including visceral adipose tissue, skeletal muscle, heart, brain, kidneys, and lungs. These changes involve endothelial dysfunction, which in turn (i) impacts control of vascular tone, (ii) contributes to development of microvascular insulin resistance, (iii) alters secretion of paracrine factors like nitric oxide and endothelin, but (iv) also influences vascular structure and perivascular inflammation. In concert, these changes impair organ perfusion and organ function thereby contributing to altered release and clearance of neurohumoral factors, such as adipokines and inflammatory cytokines. Global microvascular dysfunction in obese subjects is therefore a common pathway that not only explains exercise-intolerance but also predisposes to development of chronic kidney disease, microvascular dementia, coronary microvascular angina, heart failure with preserved ejection fraction, chronic obstructive pulmonary disease, and pulmonary hypertension.


Adipose tissue; Endothelial dysfunction; Insulin resistance; Microvascular disease; Obesity

[Indexed for MEDLINE]

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