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Impaired Microvascular Function in Obesity: Implications for Obesity-Associated Microangiopathy, Hypertension, and Insulin Resistance
Open accessAbstract
BACKGROUND: Obesity is associated with an increased risk of developing microangiopathy, hypertension, and insulin resistance. We hypothesized that obesity is a primary cause of microvascular dysfunction, which may contribute to the development of these obesity-related disorders. METHODS AND RESULTS: We examined microvascular function in 16 lean (body mass index <24 kg/m2) and 12 obese (body mass index >30 kg/m2) healthy women (mean age, 38.9+/-6.7 years) in the basal state and during physiological systemic hyperinsulinemia. We determined skin capillary recruitment after arterial occlusion with capillaroscopy and skin endothelium-(in)dependent vasodilation by iontophoresis of acetylcholine and sodium nitroprusside. Obese women, compared with lean women, had higher systolic blood pressure (P<0.05), impaired insulin sensitivity (P<0.01), impaired capillary recruitment in the basal state (P<0.05) and during hyperinsulinemia (P<0.05), and impaired acetylcholine-mediated vasodilation in the basal state (P<0.05) and during hyperinsulinemia (P<0.01). Sodium nitroprusside-mediated vasodilation was similar in lean and obese women. Capillary recruitment and acetylcholine-mediated vasodilation were positively correlated with insulin sensitivity (r=0.58, P<0.01 and r=0.55, P<0.01, respectively) and negatively with blood pressure (r=-0.64, P<0.001 and r=-0.42, P<0.05, respectively) in both lean and obese women. CONCLUSIONS: Obesity is characterized by impaired microvascular function in the basal state and during hyperinsulinemia and, in both lean and obese women, microvascular dysfunction is associated with increased blood pressure and decreased insulin sensitivity. These findings are consistent with a contribution of impaired microvascular function to the development of obesity-related microangiopathy, hypertension, and insulin resistance.
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“While, to the authors’ knowledge, publications that experimentally and explicitly demonstrate the effect of obesity or BMI on the PPG waveform are limited, we will explore works which suggest that there would be a substantial effect [56,59,60,61,62,63,64,65,66,67,68,69,70].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [65]
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“In adults, while some studies show that at rest there is no significant change in dermal capillary density, the majority of findings find that dermal capillary density does negatively correlate on average with increasing BMI [62,63,64,65].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [65]
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“Insulin-induced capillary recruitment and microvascular dilation, measured by laser Doppler flowmetry during iontophoresis of acetylcholine, correlate with insulin sensitivity and are reduced in obese compared to lean women.”
From The Vasculature in Prediabetes (2018) · cites this paper as [108]
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Metadata
- Authors
- de Jongh, R. T., Serné, E. H., IJzerman, R. G., de Vries, G., & Stehouwer, C. D. A.
- Affiliations
- From the Department of Medicine (R.T.J., E.H.S., R.G.I.J., G.V., C.D.A.S.), VU University Medical Center, Amsterdam, Netherlands, and Institute for Cardiovascular Research, Vrije Universiteit (R.T.J., E.H.S., R.G.I.J., C.D.A.S.), Amsterdam, Netherlands.
- Amsterdam Cardiovascular Sciences (NL)
- Venue
- Circulation
- Published
- 2004-06
- Volume
- 109
- Issue
- 21
- Pages
- 2529-2535
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2170401329
- Cited by
- 407
- References
- 33
- Citations by year
- 2026: 20 · 2025: 7 · 2024: 16 · 2023: 11 · 2022: 9 · 2021: 24 · 2020: 17 · 2019: 17 · 2018: 18 · 2017: 16 · 2016: 16 · 2015: 23 · 2014: 30 · 2013: 25 · 2012: 14
- FWCI
- 42.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- ZonMw (940-37-025)
- Diabetes Fonds
- Topics
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
- Keywords
- obesity, microvascular dysfunction, capillary recruitment, endothelium-dependent vasodilation, acetylcholine, sodium nitroprusside, hyperinsulinemia, insulin resistance, hypertension, microangiopathy, iontophoresis, women
- MeSH terms
- Adult, Capillaries, Female, Humans, Hyperemia, Hyperinsulinism, Hypertension, Insulin, Insulin Resistance, Microcirculation, Middle Aged, Nails, Obesity, Skin, Skin Temperature, Thinness, Vascular Diseases, Body Mass Index, Blood Pressure Monitoring, Ambulatory, Metabolic Syndrome
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