Morales-Villegas E
MAC-CMQ Hospital, Aguascalientes, Mexico, República del Perú 102-201-C. Las Américas. Aguascalientes, México. 20230.
Curr Hypertens Rev. 2014 Jul 1.
The main current threat to the human race is the correlation and synergy between two determining triumvirates of atherosclerosis, cardiovascular disease and death. The first triumvirate is constituted by obesity, metaflammation and insulin resistance; the second triumvirate is constituted by atherogenic dyslipidemia, hypertension and type 2 diabetes mellitus. The etiopathogenic driving force for both triumvirates is the global epidemic of obesity. Metaflammation and insulin resistance are associated with obesity; in turn, insulin resistance determines a high risk for the development of atherogenic dyslipidemia, hypertension and type 2 diabetes mellitus, the three of them being factors responsible for vascular endothelial injury and substrates involved in the genesis of atherosclerosis, cardiovascular disease and death. The present chapter will address both triumvirates. Firstly, the current concepts of obesity, metaflammation and insulin resistance will be reviewed; emphasizing the second (metaflammation) for being a concept that has revolutionized and integrated our understanding of the harmful effects of obesity. Secondly, the impact of insulin resistance in the regulation of intermediary metabolism and endothelial function will be addressed; this will facilitate the understanding of the inextricable link between atherogenic dyslipidemia, hypertension and type 2 diabetes mellitus. Thus, this chapter aims to present to the clinician the best knowledge to link epidemics of obesity and cardiovascular death, through the sequence of metaflammation, insulin resistance and cardiovascular risk factors (mixed dyslipidemia, hypertension and type 2 diabetes mellitus).
当前对人类的主要威胁是动脉粥样硬化、心血管疾病和死亡这两个决定性的三元组之间的关联和协同作用。第一个三元组由肥胖、代谢性炎症和胰岛素抵抗组成；第二个三元组由致动脉粥样硬化性血脂异常、高血压和2型糖尿病组成。这两个三元组的病因驱动因素都是肥胖的全球流行。代谢性炎症和胰岛素抵抗与肥胖相关；反过来，胰岛素抵抗决定了发生致动脉粥样硬化性血脂异常、高血压和2型糖尿病的高风险，这三者都是导致血管内皮损伤的因素以及参与动脉粥样硬化、心血管疾病和死亡发生的底物。本章将讨论这两个三元组。首先，将回顾肥胖、代谢性炎症和胰岛素抵抗的当前概念；重点强调第二个概念（代谢性炎症），因为它彻底改变并整合了我们对肥胖有害影响的理解。其次，将探讨胰岛素抵抗在中间代谢调节和内皮功能中的影响；这将有助于理解致动脉粥样硬化性血脂异常、高血压和2型糖尿病之间密不可分的联系。因此，本章旨在通过代谢性炎症、胰岛素抵抗和心血管危险因素（混合性血脂异常、高血压和2型糖尿病）的序列，向临床医生展示将肥胖流行与心血管死亡联系起来的最佳知识。
