Adiposopathy: Is Sick Fat a Cardiovascular Disease?

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Abstract

Being overweight or obese is a worldwide epidemic. Adiposity can cause fat

mass–related cardiovascular disease (CVD). Adiposity may also cause

adipocyte and adipose tissue anatomic and functional abnormalities, termed

adiposopathy (adipose-opathy) or " sick fat, " that result in endocrine and

immune derangements. Adiposopathy may directly contribute to CVD through

pericardiac and perivascular effects on the myocardium and blood vessels.

Adiposopathy may also indirectly contribute to CVD through promoting or

worsening major CVD risk factors such as type 2 diabetes mellitus, high

blood pressure, and dyslipidemia. Despite CVD being the most common cause of

mortality among overweight individuals, the pathophysiologic relationship

between adiposity and CVD is often thought mysterious, as evidenced by

" obesity paradoxes. "

Underlying this uncertainty are suggestions that excessive body fat does not

always increase the risk of CVD and, in some cases, may actually decrease

such risks. These paradoxical findings are made less paradoxical when the

pathogenic potential of excessive body fat is assessed based on adipose

tissue dysfunction rather than simply on increased fat mass alone.

This introductory review 1) provides a brief historical perspective of the

pathogenic potential of adipose tissue; 2) describes the relationships

between adipose tissue (histology, embryology, and adipogenesis) and

cardiovascular medicine; 3) outlines the anatomic, functional, endocrine,

and immune manifestations of adiposopathy; and 4) describes the importance

of cross talk and/or interactions of adipose tissue with other body tissues.

Finally, this review describes how " sick fat " helps account for various

clinical obesity/cardiovascular paradoxes, supporting adiposopathy as a

cardiovascular disease.

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Ortiz, MS, RD

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