Figure 1.

Pathophysiology of hypertrophic epicardial adipocytes. In obese subjects, triglycerides accumulation in adipocytes makes them hypertrophic. This result in a cellular and molecular inflammatory cascade with both positive and negative feedbacks involving VEGF and MCP-1. The mechanism determines macrophages accumulation with release of cytokines and relative local insulin-resistance with acceleration of lipolysis and release of FFA and reduction of adiponectin levels, and the increase in vascularization due to the increase in leptin and VEGF. VEGF, vascular endothelial growth factor; TNF-α, tumor necrosis factor α; MCP-1, monocyte chemoattractant protein-1; IL-10, interleukin-10; IL-8, interleukin-8; IL-1β, interleukin-1β; IL-6, interleukin-6; FFA, free fatty acids.