Obesity: A Risk Marker or an Independent Risk Factor for Coronary Artery Disease?

We congratulate Pereira et al. for their study investigating the role of obesity as a risk factor for coronary artery disease (CAD) using coronary computed tomography angiography. The study included 1,383 patients, none with a history of CAD.

Obesity is a multifactorial chronic disease, characterized by accumulation of subcutaneous and visceral fat, that predisposes individuals to metabolic disorders. Several mechanisms are involved in the association between obesity and atherosclerosis, including lipid abnormalities, insulin resistance, chronic inflammation, endothelial dysfunction, reduction of fibrinolysis and hypercoagulability. In addition, the production of proinflammatory cytokines, such as IL-6, TNF-alpha, MCP-1 and leptin contributes to chronic subclinical inflammation. More recent data have indicated that impaired autophagy and altered gut microbiome homeostasis are contributing factors for the development of atherosclerosis in obese individuals.

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