Cytokine abnormalities in the etiology of the cardiometabolic syndrome.

The cardiometabolic syndrome comprises a cluster of risk factors, including abdominal obesity, dyslipidemia, hypertension, insulin resistance/glucose intolerance, and proteinuria. This syndrome is due, in part, to the accumulation of visceral fat, which promotes synthesis of proinflammatory adipokines resulting in a visceral adipose tissue-specific increase in reactive oxygen species derived from NADPH oxidase. Adipose tissue oxidative stress results in the development of systemic oxidative stress and inflammation, which further lead to development of metabolic dyslipidemia, impaired glucose metabolism, renal disease, and hypertension. Importantly, visceral-not subcutaneous-fat is the significant source of the circulating adipokines that promote these systemic abnormalities. Chronic low-grade inflammation develops within adipose tissue because of the additional infiltration and accumulation of inflammatory macrophages. There is evidence that lifestyle changes, bariatric surgery, and/or administration of insulin-sensitizing, anti-inflammatory, or antihypertensive drugs that address the risk factors promoting the cardiometabolic syndrome act, in part, by promoting an anti-inflammatory adipokine profile in visceral fat.