Visceral adipose tissue and residual cardiovascular risk: a pathological link and new therapeutic options

Abstract

Obesity is a heterogeneous disease that affects almost one-third of the global population. A clear association has been established between obesity and cardiovascular disease (CVD). However, CVD risk is known to be related more to the local distribution of fat than to total body fat. Visceral adipose tissue (VAT) in particular has a high impact on CVD risk. This manuscript reviews the role of VAT in residual CV risk and the available therapeutic strategies for decreasing residual CV risk related to VAT accumulation. Among the many pathways involved in residual CV risk, obesity and particularly VAT accumulation play a major role by generating low-grade systemic inflammation, which in turn has a high prognostic impact on all-cause mortality and myocardial infarction. In recent years, many therapeutic approaches have been developed to reduce body weight. Orlistat was shown to reduce both weight and VAT but has low tolerability and many drug-drug interactions. Naltrexone-bupropion combination lowers body weight but has frequent side effects and is contraindicated in patients with uncontrolled hypertension. Liraglutide and semaglutide, glucagon-like peptide 1 (GLP-1) agonists, are the latest drugs approved for the treatment of obesity, and both have been shown to induce significant body weight loss. Liraglutide, semaglutide and other GLP-1 agonists also showed a positive effect on CV outcomes in diabetic patients. In addition, liraglutide showed to specifically reduce VAT and inflammatory biomarkers in obese patients without diabetes. GLP-1 agonists are promising compounds to limit inflammation in human visceral adipocytes.

Bioactive Compounds Formulated in Phytosomes Administered as Complementary Therapy for Metabolic Disorders

“…The group of Rondanelli M. et al [156] evaluated the effect of bergamot phytoconstituents formulated in phytosomes (Bergamot Phytosome, Vazguard, Indena SpA) on visceral adipose tissue, as an indicator for the metabolic syndrome, DM and CVD [207,208] in overweight and obese class I subjects. After one month of treatment with bergamot phytosomes, the subjects showed a significant reduction in visceral adipose tissue compared to the placebo group [156].…”

Are we ready for an adipocentric approach in people living with type 2 diabetes and chronic kidney disease?

“…The systemic effects associated with dysfunctional ectopic adiposity, together with the local source of mediators, can lead to compressive organ damage around the kidney, contributing to hypertension and abnormal blood pressure variability [ 6 , 7 ]. The development of steatotic liver disease associated with metabolic dysfunction further amplifies systemic inflammation and insulin resistance, which become self-perpetuating [ 65 ]. In addition, epicardial, pericardial ectopic and perivascular fat promotes arrhythmogenesis, myocardial dysfunction and coronary atherosclerosis [ 66 , 67 ].…”

Relevance of obesity-related organ damage and metabolic syndrome classification in cardiovascular and renal risk stratification in patients with essential hypertension

“…Several studies showed a direct correlation between the imbalance of CV regulatory systems and the adipose tissue, this latter representing the hemodynamic hallmark for high blood pressure (BP) and abnormalities in microcirculation ( 1 , 2 ). The relationship between obesity and hypertension has been established since the Framingham Heart Study ( 3 ) and it is well known that excess adiposity increases the risk for cardiometabolic diseases, especially considering the visceral adipose tissue ( 4 ).…”

“…As regards this, in a cohort of patients with comorbidities such as hypertension and diabetes mellitus admitted in a hospital for elective coronary angiography, Kannel found that abdominal visceral fat was increased in patients with concentric hypertrophy ( 3 ). Thus, the assessment of abdominal visceral fat allows one to identify, among patients with cardiometabolic comorbidities such as arterial hypertension, a leading cause of increased mortality ( 4 ).…”