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Review
. 2023 Jul 27:10:1187735.
doi: 10.3389/fcvm.2023.1187735. eCollection 2023.

Visceral adipose tissue and residual cardiovascular risk: a pathological link and new therapeutic options

Arturo Cesaro  1   2 , Gianantonio De Michele  1   2 , Fabio Fimiani  3 , Vincenzo Acerbo  1   2 , Gianmaria Scherillo  1   2 , Giovanni Signore  1   2 , Francesco Paolo Rotolo  1   2 , Francesco Scialla  1   2 , Giuseppe Raucci  1   2 , Domenico Panico  1   2 , Felice Gragnano  1   2 , Elisabetta Moscarella  1   2 , Olga Scudiero  4   5   6 , Cristina Mennitti  4 , Paolo Calabrò  1   2
Affiliations
Review

Visceral adipose tissue and residual cardiovascular risk: a pathological link and new therapeutic options

Arturo Cesaro et al. Front Cardiovasc Med. .

Abstract

Obesity is a heterogeneous disease that affects almost one-third of the global population. A clear association has been established between obesity and cardiovascular disease (CVD). However, CVD risk is known to be related more to the local distribution of fat than to total body fat. Visceral adipose tissue (VAT) in particular has a high impact on CVD risk. This manuscript reviews the role of VAT in residual CV risk and the available therapeutic strategies for decreasing residual CV risk related to VAT accumulation. Among the many pathways involved in residual CV risk, obesity and particularly VAT accumulation play a major role by generating low-grade systemic inflammation, which in turn has a high prognostic impact on all-cause mortality and myocardial infarction. In recent years, many therapeutic approaches have been developed to reduce body weight. Orlistat was shown to reduce both weight and VAT but has low tolerability and many drug-drug interactions. Naltrexone-bupropion combination lowers body weight but has frequent side effects and is contraindicated in patients with uncontrolled hypertension. Liraglutide and semaglutide, glucagon-like peptide 1 (GLP-1) agonists, are the latest drugs approved for the treatment of obesity, and both have been shown to induce significant body weight loss. Liraglutide, semaglutide and other GLP-1 agonists also showed a positive effect on CV outcomes in diabetic patients. In addition, liraglutide showed to specifically reduce VAT and inflammatory biomarkers in obese patients without diabetes. GLP-1 agonists are promising compounds to limit inflammation in human visceral adipocytes.

Keywords: GLP-1 agonists; liraglutide; obesity; residual cardiovascular risk; semaglutide; visceral adipose tissue.

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Conflict of interest statement

The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer AM declared a past co-authorship with the authors AC and PC to the handling editor.

Figures

Figure 1
Figure 1
Schematic diagram from visceral adipose tissue to cardiovascular damage.
Figure 2
Figure 2
Effects of liraglutide on visceral adipose tissue and weight reduction (data from three reviews) (–123).
See this image and copyright information in PMC

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