Department of Internal Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy.
Curr Pharm Des. 2013;19(13):2382-9. doi: 10.2174/1381612811319130006.
Endothelium plays a crucial role in modulating vascular function and structure, mainly by production of nitric oxide which protects the vasculature against the development of atherosclerosis and thrombosis. Traditional cardiovascular risk factors are characterized by endothelial dysfunction caused by an enhanced production of oxidative stress leading to destroy NO thus reducing its availability. A reduced endothelium-dependent relaxation is a predictor of cardiovascular events in high risk patients. Abdominal obesity is associated with microvascular endothelial dysfunction, through indirect mechanisms, such as insulin-resistance and the association with risk factors (including diabetes mellitus, hypertension and dyslipidemia), and directly, among others, by the production of adipokines and pro-inflammatory cytokines which in turn induce oxidative stress leading to a reduced NO availability. Several systems are amplified by the concomitant obesity and hypertension, thus generating a perpetual vicious circle which further contribute to the pathogenesis/progression of microvascular disease. Weight loss and modification of life-style ameliorate endothelial function in obese patients. It is conceivable that endothelial dysfunction might represent a complementary but crucial objective of a modern therapeutical approach leading to improve the prognosis in many patients, including obese patients, exposed to a high cardiovascular risk.
内皮细胞在调节血管功能和结构方面起着至关重要的作用，主要通过产生一氧化氮来保护血管免受动脉粥样硬化和血栓形成的发展。传统的心血管危险因素的特征是内皮功能障碍，这是由于氧化应激的产生增强导致一氧化氮的破坏，从而降低其可用性。内皮依赖性松弛的减少是高危患者心血管事件的预测指标。腹部肥胖与微血管内皮功能障碍有关，通过间接机制，如胰岛素抵抗和与危险因素（包括糖尿病、高血压和血脂异常）的关联，以及直接通过产生脂肪因子和促炎细胞因子，从而诱导氧化应激，导致一氧化氮的可用性降低。在肥胖和高血压的同时，几个系统被放大，从而产生一个持续的恶性循环，进一步促进微血管疾病的发病机制/进展。减肥和生活方式的改变可以改善肥胖患者的内皮功能。可以想象，内皮功能障碍可能代表一种补充但关键的现代治疗方法的目标，从而改善许多患者的预后，包括肥胖患者，他们面临着高心血管风险。
