The American Journal of Medicine
Volume 123, Issue 8 , Pages 727-734, August 2010

Paradoxical Preservation of Vascular Function in Severe Obesity

  • Luigi Marzio Biasucci, MD

      Affiliations

    • Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
    • Corresponding Author InformationReprint requests should be addressed to: Luigi Marzio Biasucci, MD, Institute of Cardiology, Catholic University, Largo Gemelli 8, 00168 Roma, Italy
    • ,
  • Francesca Graziani, MD

      Affiliations

    • Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
    • ,
  • Vittoria Rizzello, MD, PhD

      Affiliations

    • Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
    • ,
  • Giovanna Liuzzo, MD, PhD

      Affiliations

    • Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
    • ,
  • Caterina Guidone, MD

      Affiliations

    • Institute of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy
    • ,
  • Alberto Ranieri De Caterina, MD

      Affiliations

    • Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
    • ,
  • Salvatore Brugaletta, MD

      Affiliations

    • Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
    • ,
  • Gertrude Mingrone, MD

      Affiliations

    • Institute of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy
    • ,
  • Filippo Crea, MD

      Affiliations

    • Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy

Abstract 

Background

Obesity is associated with a high risk of coronary artery disease morbidity and mortality. Yet, postmortem studies have shown that severely obese subjects exhibit smooth coronary arteries, thus suggesting that they may be protected from atherosclerosis. We assessed vascular function and its possible determinants in a cohort of normal-weight to severely obese insulin-sensitive subjects (body mass index [BMI] 23.2-49 kg/m2).

Methods

Seventy-one healthy, insulin-sensitive subjects (Homeostasis Model Assessment of Insulin Resistance index <2.5), divided into normal-weight (n = 13; BMI = 23.2 ± 1.6), obese (n = 35; BMI=32.6±2.5), and severely obese (n=23; BMI=49.0±7.9) groups, were enrolled. Vascular function was evaluated by flow-mediated dilation and carotid intima–media thickness. High-sensitivity C-reactive protein, leptin, adiponectin, vascular growth factors, and CD34+KDR+/CD133+ endothelial progenitor cells, known markers of vascular health/protection, also were measured.

Results

Flow-mediated dilation was higher in severely obese than in obese and normal-weight individuals (P=.019 and P=.011 respectively). Intima–media thickness was consistently lower in severely obese than in obese individuals (P=.040) and similar in severely obese and normal-weight individuals (P >.99). Levels of high-sensitivity C-reactive protein and leptin were higher in severely obese than in obese and normal-weight individuals (high-sensitivity C-reactive protein: P=.018 and P=.05, respectively; leptin: P <.001 for both comparisons). CD34+KDR+ endothelial progenitor cells were significantly higher in severely obese versus obese individuals (P=.039).

Conclusion

Our study demonstrates that vascular function is paradoxically better in severely obese than in obese subjects and similar to that found in normal-weight subjects. Despite higher levels of high-sensitivity C-reactive protein and leptin, severely obese individuals may be partially protected from atherosclerosis, possibly by a greater mobilization of endothelial progenitor cells.

Keywords: Endothelial function, Inflammation, Obesity

 

 Funding: The study was funded by grant 70200400 from Catholic University of the Sacred Heart, Rome, Italy.

 Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(10)00345-1

doi:10.1016/j.amjmed.2010.02.016

The American Journal of Medicine
Volume 123, Issue 8 , Pages 727-734, August 2010

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