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Adipose tissue promoting atherothrombosis

Cardiovascular Pharmacology and Pharmacotherapy

From a mechanistic standpoint, the role of adipose tissue in the regulation of inflammation and thrombogenesis was revised by Dr Thomas Weiss from Vienna, Austria and Raffaele de Caterina from Chieti, Italy.
Dr. Weiss showed the implication of inflammation in obese patients, how obesity-triggered inflammation may affect intima-media thickness (IMT) and atherosclerosis.
Dr Weiss concluded from his work in obese patients with hypertriglyceridemia that MMP9, IL6ts IL18mRNA and IL18mRNA expression are associated with cardiovascular disease (CVD).

In a hypothesis-generating study, Dr Weiss together with Profs. Arnesen and Seljeflot from Oslo, coined the term APPIA score (for "Adipose Tissue Proinflammatory Activity") that closely relates to IMT and the presence of CVD. Interestingly, this presentation was followed by the revision by Prof de Caterina on how obesity and obesity-related factors affect thrombogenicity.
Prof de Caterina thoroughly analyzed the many possible factors by which thrombosis can be stimulated. Effects of platelets, coagulation and fibrinolysis are reported in the literature as being associated with obesity and the metabolic syndrome factors.

The importance of obesity as a risk factor for coronary artery disease (CAD) and the therapeutic options for obesity in CAD were then analyzed by Drs Christian Torp-Pedersen from Hellerup, Denmark and Jean-Pierre Despres from Quebec, Canada.
Dr Torp-Pedersen critically analyzed the existing literature and his own work on the relation of obesity with CAD. While in primary prevention, losing weight is always indicated in patients with existing CVD, the results of large metanalysis are not conclusive at all, and indeed, moderate obesity may even show a minor protective effect. The reasons behind these controversial results and the obesity-paradox remain elusive and deserve further investigation.

Dr Despres asked in his presentation why we should treat obesity and whether we should target weight loss or upstream behavior. He acknowledged that whether the excess of body fat is associated with increased risk of morbidity and mortality is becoming a matter of debate.
A debate that is complicated, because it should include the effects of the different fat types and how to determine the fat pools. Indeed, excess visceral adiposity/ectopic fat seems to better define high risk in obesity than body mass index (BMI), a parameter that encompasses total body fat.
As Dr Despres concluded, "the healthy functional adipose tissue -usually subcutaneous fat- should be clearly differentiated from unhealthy dysfunctional adipose-usually visceral fat tissue that is found in metabolically diseased patients".

More research is needed to identify the mechanisms by which adipose tissue from different fat deposits contributes to vascular risk, and the type of fat and fat-derived products that drive the different level of complications in metabolically healthy versus metabolically-affected patients.


Session Title: Adipose tissue promoting atherothrombosis

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.