Obesity Related Coronary Microvascular Dysfunction: From Basic to Clinical Practice.
Obesity related coronary microvascular disease is a medical entity which is not yet fully elucidated. The pathophysiological basis of coronary microcirculatory dysfunction consists of a heterogeneous group of disorders with individual morphologic/functional/clinical presentation and prognosis. Coronary microcirculatory changes include mechanisms connected with vascular dysfunction, as well as extravascular and vasostructural changes in responses to neural, mechanical, and metabolic factors. Cardiometabolic changes that include obesity, dyslipidemia, diabetes mellitus type II, and hypertension are associated with atherosclerosis of epicardial coronary arteries and/or microvascular coronary dysfunction, with incompletely understood underlying mechanisms. In obesity, microvascular disease is mediated via adipokines/cytokines causing chronic, subclinical inflammation with (a) reduced NO-mediated dilatation, (b) changed endothelial- and smooth muscle-dependent vasoregulating mechanisms, (c) altered vasomotor control with increased sympathetic activity, and (d) obesity related hypertension with cardiomyocytes hypertrophy and impaired cardiac vascular adaptation to metabolic needs. From a clinical point of view it can present itself in acute or chronic form with different prognosis, as a practice problem for real-life diagnosis and treatment.
Department for Cardiovascular Disease, Osijek University Hospital, J. Huttlera 4, 31000 Osijek, Croatia; Department for Internal Medicine, Faculty of Medicine, University of Osijek, Cara Hadrijana 10E, 31000 Osijek, Croatia.
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Selthofer-Relatić
Department for Cardiovascular Disease, Osijek University Hospital, J. Huttlera 4, 31000 Osijek, Croatia.
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Bošnjak
Department for Cardiovascular Disease, Osijek University Hospital, J. Huttlera 4, 31000 Osijek, Croatia; Department for Physiology and Immunology, Faculty of Medicine, University of Osijek, Cara Hadrijana 10E, 31000 Osijek, Croatia.
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Kibel