The Impact of Vascular Dysfunction in Obesity and Diabetes

Dear Colleagues,

The impact of vascular dysfunction in obesity and diabetes is a complex and critical problem with far-reaching health implications. Vascular dysfunction, a common and early feature in both conditions, plays a significant role in the development of cardiovascular diseases, which are major causes of morbidity and mortality worldwide. In this special issue we will highlight the mechanisms linking vascular dysfunction to obesity and diabetes and consider the consequences and potential therapeutic strategies. Original articles and reviews are welcome.

Obesity and diabetes are associated with impaired endothelial function, characterized by a reduction in the bioavailability of vasodilators such as nitric oxide (NO). This impairment is often due to oxidative stress, inflammation, and the increased production of vasoconstrictors. In addition, in both obesity and type 2 diabetes, insulin resistance leads to reduced stimulation of endothelial NO synthase, which impairs NO production and endothelial function. In obesity, excess adipose tissue, particularly visceral, secretes pro-inflammatory cytokines (eg. tumor necrosis factor-alpha and interleukin-6) and adipokines that can promote systemic inflammation, contributing to endothelial damage and vascular dysfunction. Both conditions exhibit an increased infiltration of immune cells into vascular walls, further exacerbating inflammation and endothelial injury. Chronic high blood glucose levels in diabetes contribute to the formation of advanced glycation end-products, which can alter the structure and function of vascular tissues, promoting stiffness and reducing elasticity.

The impact on vascular function is significant. Damaged endothelial cells and inflammation lead to the development of atherosclerosis, characterized by plaque formation within arteries, increasing the risk of coronary artery disease and stroke. Impaired vascular function can result in increased peripheral resistance, a hallmark of hypertension, which is commonly observed in individuals with obesity and diabetes. In diabetes, the microvascular complications include retinopathy, nephropathy, and neuropathy, which arise from damage to the small blood vessels supplying the eyes, kidneys, and nerves, respectively. In addition, both obesity and diabetes are risk factors for heart failure, often independent of coronary artery disease, potentially through mechanisms involving myocardial steatosis, lipotoxicity, and diabetic cardiomyopathy.

Understanding and managing vascular dysfunction in obesity and diabetes is crucial for reducing the burden of associated cardiovascular diseases. Continuous research and innovative treatments are imperative to improve outcomes for affected populations globally. Lifestyle modifications (diet, exercise, and weight loss are foundational in managing obesity and diabetes), therapeutic interventions (antidiabetic drugs like agonist of glucagon-like peptide-1, sodium-glucose cotransporter 2 inhibitors not only control blood glucose levels but also show benefits in reducing cardiovascular risks; antihypertensives: angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are particularly effective in patients with diabetes, as they protect against kidney damage while controlling blood pressure; statins) or surgical interventions can lead to improvements in vascular function.

We need tailoring treatments based on genetic, metabolic, and environmental factors that could enhance efficacy and minimize side effects. Research into new drugs that directly target pathways specific to vascular dysfunction in obesity and diabetes holds promise. Finally, greater focus on preventive measures, including early lifestyle interventions, could mitigate the onset of vascular complications associated with obesity and diabetes.

Dr. Cristina M. Sena
Guest Editor

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• vascular dysfunction
• insulin resistance
• inflammation
• adipokines and cytokines
• microvascular complications
• pharmacological treatments
• surgical interventions
• cardiovascular diseases
• personalized medicine
• novel therapeutics
• prevention strategies