[Dyslipidemia in visceral obesity: pathophysiological mechanisms, clinical implications and therapy].
Visceral (intra-abdominal) obesity is associated with a cluster of cardiovascular risk factors that together promote macrovascular and microvascular disease. An atherogenic dyslipidemia, characterized by an increase in serum triglyceride-rich lipoproteins, a decrease in plasma levels of high-density lipoprotein cholesterol and increased prevalence of small, dense low-density lipoprotein particles (although low-density lipoprotein cholesterol levels are normal or only modestly elevated), as well as chronic inflammation, play key roles in the pathogenesis of visceral obesity-related complication. These abnormalities may be consequent to a global metabolic effect of insulin resistance. Pharmacological treatments, such as 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, fibric acid derivatives, insulin sensitizers and cannabinoid receptor type 1 blockers, are often required to correct the dyslipidemia of visceral obesity. The basis for a multiple approach to correcting dyslipoproteinemia in visceral obesity and the metabolic syndrome relies on understanding the mechanisms of action of the individual therapeutic components.
Zambon
Alberto
A
Clinica Medica 1, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi, Padova. alberto.zambon@unipd.it
Marchiori
Michela
M
Manzato
Enzo
E
D050197:Atherosclerosis / Q000209:etiology; D001920:Bradykinin / Q000037:antagonists & inhibitors; D063387:Cannabinoid Receptor Antagonists; D002186:Cannabinoids / Q000037:antagonists & inhibitors; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000097:blood; D002995:Clofibric Acid / Q000627:therapeutic use; D050171:Dyslipidemias / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D015201:Meta-Analysis as Topic; D009765:Obesity / Q000097:blood / Q000150:complications*; D010880:Piperidines / Q000627:therapeutic use; D011446:Prospective Studies; D011720:Pyrazoles / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000077285:Rimonabant; D012737:Sex Factors
D063387:Cannabinoid Receptor Antagonists; D002186:Cannabinoids; D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D010880:Piperidines; D011720:Pyrazoles; D002995:Clofibric Acid; D000077285:Rimonabant; D001920:Bradykinin