Figure 4).

Patients in chronic positive energy balance and deficient lipid partitioning, which may be at least in part dependent on leptin resistance, will develop ectopic fat accumulation. Abdominal fat promotes the formation of small, dense low-density lipoprotein (LDL) particles as well as lower level of high-density lipoproteins (HDLs), which in turn have detrimental roles in the development of atherosclerotic plaque. Accumulation of ectopic epicardial fat could influence atherosclerosis development through the production of cytokines diffusing to the plaque by the vasa vasorum and neo-vascularization process