Hemostasis, endothelial stress, inflammation, and the metabolic syndrome

• Published in: Seminars in immunopathology Vol. 40; no. 2; pp. 215 - 224
• Main Authors: Grandl, Gerald, Wolfrum, Christian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2018; Springer Nature B.V
• Subjects: Animals; Biomedical and Life Sciences; Biomedicine; Blood pressure; Cardiovascular diseases; Diabetes mellitus; Diet, Western - adverse effects; Endothelium, Vascular - metabolism; Endothelium, Vascular - physiopathology; Fatty acids; Health risk assessment; Hemostasis; Humans; Immunology; Inflammation; Inflammation - etiology; Inflammation - metabolism; Inflammation - physiopathology; Inflammatory diseases; Insulin; Insulin resistance; Internal Medicine; Lipids; Metabolic syndrome; Metabolic Syndrome - etiology; Metabolic Syndrome - metabolism; Metabolic Syndrome - physiopathology; Obesity; Oxidative Stress - physiology; Review; Type 2 diabetes; Obesity; NO; Reactive oxygen species; Hemostasis; Nitric oxide; Coagulation; ROS; Inflammation; Metabolic syndrome; Platelets; Endothelial stress
• ISSN: 1863-2297; 1863-2300; 1863-2300
• DOI: 10.1007/s00281-017-0666-5

Obesity and the metabolic syndrome (MS) are two of the pressing healthcare problems of our time. The MS is defined as increased abdominal obesity in concert with elevated fasting glucose levels, insulin resistance, elevated blood pressure, and plasma lipids. It is a key risk factor for type 2 diabetes mellitus (T2DM) and for cardiovascular complications and mortality. Here, we review work demonstrating that various aspects of coagulation and hemostasis, as well as vascular reactivity and function, become impaired progressively during chronic ingestion of a western diet, but also acutely after meals. We outline that both T2DM and cardiovascular disease should be viewed as inflammatory diseases and describe that chronic overload of free fatty acids and glucose can trigger inflammatory pathways directly or via increased production of ROS. We propose that since endothelial stress and increases in platelet activity precede inflammation and overt symptoms of the MS, they are likely the first hit. This suggests that endothelial activation and insulin resistance are probably causative in the observed chronic low-level metabolic inflammation, and thus both metabolic and cardiovascular complications linked to consumption of a western diet.