Sympathetic Nervous System, Hypertension, Obesity and Metabolic Syndrome
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ORIGINAL ARTICLE
Sympathetic Nervous System, Hypertension, Obesity and Metabolic Syndrome Gino Seravalle1 • Guido Grassi2,3
Received: 8 February 2016 / Accepted: 26 February 2016 Ó Springer International Publishing Switzerland 2016
Abstract Experimental and clinical studies have clearly shown the role of the sympathetic nervous system in the pathophysiology of several cardiovascular and non-cardiovascular diseases. This short review will be aimed at focusing and discussing the new information collected on two specific clinical conditions such as obesity and metabolic syndrome. The paper will briefly describe the four main mechanisms that represent the common link between these two pathophysiological conditions and that through the sympathetic nervous system contribute to increase the cardiovascular risk. Keywords Sympathetic nervous system Obesity Metabolic syndrome Insulin resistance Leptin Baroreflex
1 Introduction The metabolic syndrome is characterized by the simultaneous occurrence of metabolic abnormalities including obesity, glucose intolerance, dyslipidemia and hypertension, that result in a marked increase in cardiovascular morbidity and mortality [1]. High blood pressure is a classical feature of the metabolic syndrome and it has been reported that the metabolic syndrome is present in up to 30 % of hypertensive patients [2]. Therefore, high blood & Gino Seravalle [email protected] 1
Cardiology Department, S. Luca Hospital, Istituto Auxologico Italiano, Piazza Brescia 20, 20149 Milan, Italy
2
Clinica Medica, University Milano Bicocca, Monza, Italy
3
IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
pressure is included in the definition for the metabolic syndrome. This is also the case for obesity and in particular for visceral fat excess distribution. Obesity is much more than a cosmetic issue given its association with poor quality of life and reduced life expectancy [3]. In addition, obesity related illness place a considerable burden on the economy by increasing rates of health care usage and associated costs. The sympathetic nervous system plays an important role in the regulation of metabolic and cardiovascular homeostasis. The sympathetic nervous system activation is characteristic of a number of metabolic and cardiovascular disorders, many of which occur more frequently in obese individuals. Obesity potentiates sympathetic nervous system activation in patients with hypertension [4] and heightened sympathetic nervous system activity is associated with adverse clinical outcomes [5]. The present review will examine the role of the sympathetic nervous system in the development of the haemodynamic and metabolic abnormalities occurring in obesity and metabolic syndrome. We will also provide a brief overview of the mechanisms potentially responsible for the neuroadrenergic alterations described in these pathophysiological conditions.
2 The Metabolic Syndrome: Definition This condition is characterized by various combinations of abnormalities in body weight, glucose metabolism, l
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