Pretilost predstavlja svjetski epidemijski i veliki zdravstveni problem osobito otkako se povezuje s metaboličkim, kardijalnim i vaskularnim komplikacijama. Prema posljednjim istraživanjima, ektopično visceralno masno tkivo je važan prediktor razvoja kardiovaskularnih bolesti i inzulinske rezistencije, značajnije nego ukupno akumulirano masno tivo. Kardijalno visceralno masno tkivo čine intratorakalne, epikardijalne i intramiokardijalne masne stanice, koje su povezane i s konvencionalni kardiovaskularnim čimbenicima rizika. Adipociti su aktivane endokrine stanice koje produciraju mnogobrojne adipocitokemokine. Leptin i adiponektin su adipokini sa značajnom ulogom u razvoju kardiovaskularnih bolesti, uključujući aterosklerotske procese, hipertrofiju kardiomiocita i remodelaciju miokardnog ekstracelularnog matriksa. U stanju pretilosti koncentracija cirkulirajućeg protektivnog adiponektina je snižena, dok je koncentracija leptina povišena. Zajedno, hipoadiponektinemija i hiperleptinemija imaju proaterosklerotski i proupalni učinak, djelujući na hipertrofični signal u kardiomiocitima putem kompleksnih mehanizama. Može se zaključiti da pretilost, ektopično kardijalno masno tkivo i adipokini utječu na lokalne i sistemske, metaboličke i mehaničke promijene kardiovaskularnog sustava s patohistološkim i patofiziološkim promijenama kardiomiocita i miokarda. Rezultat svih promjena je razvoj debljinom uzrokovane kardiomiopatije s poremećajem miokardijalne relaksacije i dijastoličke funkcije.Obesity is becoming a worldwide epidemic and a major health problem, since its presence is associated with significant adverse effects on health including metabolic, cardiac and vascular complications. According to latest research, ectopic visceral fat accumulation is an important predictor of diseases, particularly of cardiovascular diseases and insulin resistance, carrying more risk than general fat accumulation. Cardiac ectopic fat includes fat deposition around the heart (epicardial and intrathoracic fat) and intra-myocardial fat cells. All ectopic fat depots are related to conventional risk factors for cardiovascular diseases. Adipocytes act as an endocrine organ, producing number of adipocytokemokines. Leptin and adiponectin are adipokines with significant role in development of cardiovascular diseases, including atherosclerosis, cardiac hypertrophy and myocardial extracellular matrix remodeling. The level of circulating protective adiponectin is decreased while leptin level is increased in obese patients. Hypoadiponectinemia and hyperleptinemia have proatherosclerotic and proinflammatory effects inducing hypertrophic signal in cardiomyocytes via complex mechanisms. It can be concluded that obesity, cardiac fat, inflammation and adipokines changes contribute to local and systemic, metabolic and mechanical changes in cardiovascular system, with pathohistological and pathophysiological changes of cardiomyocytes and myocardium. Result of all these changes is obesity related cardiomyopathy with disturbances of myocardium relaxation and diastolic dysfunction
