[Atherosclerotic and hemodynamic effects of obesity]

Obesity is a risk factor of atherosclerosis. The TG content of a fat cell is determined by the balance of lipogenesis from plasma FFA and glucose and lipolysis by hormone-sensitive lipase (HSL). Plasma FFA is produced by TG lipolysis by lipoprotein lipase (LPL). Insulin stimulates LPL activity and inhibits HSL activity. Therefore, hyperinsulinemia stimulates TG accumulation in fat cells. Insulin also stimulates fat cell proliferation. Hyperinsulinemia is a major factor for obesity. Portal FFA stimulates VLDL synthesis and gluconeogenesis and inhibits insulin degradation in the liver. Therefore, visceral obesity is important as a risk factor of atherosclerosis. However the increase of total adipose tissue mass is more important for blood pressure and cardiac performance.