Microvascular abnormalities, both in function and structure, lead to impaired tissue perfusion that may affect
multiple tissues and organs and seem to be involved in target-organ damage and complications observed in obesity and insulin
resistance. In general, vascular remodeling of small arteries associated to cardiometabolic diseases seems to be hypertrophic
and it is associated to increased extracellular matrix deposition, although specific vascular beds might show
different structural patterns. The mechanisms by which obesity, insulin resistance and/or hyperinsulimemia determine
vascular disease are not clear yet but might include hemodynamic factors such as hypertension, activation of the sympathetic
nervous and the renin-angiotensin-aldosterone systems, metabolic factors such as insulin and advanced glycation
end products and other factors such as adipokines, inflammation or oxidative stress. Exercise and weight loss as well as
blockade of the renin-angiotensin system seem to be efficient actions to correct vascular alterations in patients. This review
aims to examine the existing literature on structural alterations in small vessels associated to insulin resistance and
obesity. A description about the underlying mechanisms possibly responsible of the vascular alterations is also provided.
Moreover, effects of pharmacological and non pharmacological strategies that could modify these vascular alterations are
Keywords: Obesity, insulin resistance, remodeling, small arteries, stiffness.
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