See related article, pages 218–225 Obesity, characterized by an excess of adipose tissue mass, is closely associated with an increase in cardiovascular morbidity and mortality attributable to atherosclerosis.1 Obesity is a major underlying risk factor for atherosclerosis through other well-known risk factors, including the major risk factors (hypercholesterolemia, hypertension, hyperglycemia) and emerging risk factors (atherogenic dyslipidemia, insulin resistance, proinflammatory and prothrombotic state).2 The clinical value of novel risk factors such as high-sensitivity C-reactive protein are currently subject of ongoing discussions.3 The clustering of major and emerging risk factors that is found in most obese patients is defined as the metabolic syndrome.2 Among various cytokine-like hormones secreted by adipose tissue, the most abundant and adipose-specific is adiponectin (Figure).4 Reduced plasma levels of adiponectin, which are found in obese patients, are closely associated with obesity-related diseases, including atherosclerotic cardiovascular diseases, type 2 diabetes, hypertension, and dyslipidemia.4 Emerging experimental evidence indicates that adiponectin mediates antiatherogenic and antithrombotic effects through direct protective actions on endothelial cells, smooth muscle cells, macrophages, and platelets.1,5,6 Figure. Antiatherogenic effects of adiponectin. The cytokine-like hormone adiponectin, which is selectively expressed by adipose cells, exhibits antiatherogenic properties through direct and indirect effects on endothelial cells (EC), smooth muscle cells (SMC), platelets, macrophages, and T lymphocytes. IL indicates interleukin; IL-1RA, IL-1 receptor antagonist; NF-κB, nuclear factor κB. …
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