Vascular Remodeling in Health and Disease

The term vascular remodeling is commonly used to define the structural changes in blood vessel geometry that occur in response to long-term physiologic alterations in blood flow or in response to vessel wall injury brought about by trauma or underlying cardiovascular diseases.1, 2, 3, 4 The process of remodeling, which begins as an adaptive response to long-term hemodynamic alterations such as elevated shear stress or increased intravascular pressure, may eventually become maladaptive, leading to impaired vascular function. The vascular endothelium, owing to its location lining the lumen of blood vessels, plays a pivotal role in regulation of all aspects of vascular function and homeostasis.5 Thus, not surprisingly, endothelial dysfunction has been recognized as the harbinger of all major cardiovascular diseases such as hypertension, atherosclerosis, and diabetes.6, 7, 8 The endothelium elaborates a variety of substances that influence vascular tone and protect the vessel wall against inflammatory cell adhesion, thrombus formation, and vascular cell proliferation.8, 9, 10 Among the primary biologic mediators emanating from the endothelium is nitric oxide (NO) and the arachidonic acid metabolite prostacyclin [prostaglandin I2 (PGI2)], which exert powerful vasodilatory, antiadhesive, and antiproliferative effects in the vessel wall

Obesity, obstructive sleep apnea, and cardiovascular risk

Obesity is a major risk factor for cardiovascular disease, the number one killer of Americans. It is also a major risk factor for obstructive sleep apnea, which is rising in the US population as the obesity epidemic continues. Obstructive sleep apnea, in turn, has been implicated as a risk factor for hypertension, glucose dysregulation, and cardiovascular disease. Understanding the pathophysiologic links and the common-soil hypothesis for these rapidly growing disorders is of paramount importance for developing strategic therapeutic and preventive plans. This article discusses the associations of obesity, obstructive sleep apnea, and cardiovascular disease, highlighting the pathophysiologic mechanisms, including increased oxidative stress, endothelial dysfunction, and inflammation