From Adipose Tissue to the Heart: Leptin, Exercise, and Cardiovascular Risk in Women

Cardiovascular disease (CVD) is a leading cause of mortality in women, with sex-specific risk factors still underrepresented in research. Leptin is an adipokine released primarily from adipose tissue, with multifaceted roles contributing to cardiometabolic health. Hyperleptinemia and associated resistance influence appetite regulation, cardiac remodeling, vascular health, and sympathetic nervous system activation. The interplay of leptin and CVD health is mediated by estrogen, and the lack thereof in menopause, modifying cardiac health across the lifespan. Exercise is an important lifestyle modifier that reduces leptin levels and increases central sensitivity. Weight loss and energy intake both influence the relationship between leptin and exercise, but the exact mechanism is still unclear. Nonetheless, moderately intense aerobic exercise has promising benefits, especially for postmenopausal women. Leptin should be considered as a biomarker for CVD risk assessment and be targeted with exercise as a nonpharmacological intervention in women.