Heart Disease and the Metabolic Syndrome

In this chapter, we will link three important risk factors for heart disease: hypertension, atherosclerosis and dyslipidemia. Chronically elevated blood pressure, i.e., hypertension, increases the risk of ischemic heart disease, stroke, peripheral vascular disease and other CVDs. This is the most important preventable risk factor for premature death. The low intake of fruit and vegetables and whole grain fiber and high consumption of saturated fat and high-cholesterol diets can lead to hypercholesterolemia and atherosclerosis, especially in genetically predisposed individuals. Atherosclerosis is a chronic inflammatory disease caused by the accumulation of cholesterol-laden macrophages in the artery wall, i.e., it is based on dyslipidemia and an overreaction of the immune system. Accordingly, the susceptibility to CVDs is associated with genes affecting the serum levels of plasma lipids and lipoproteins. Furthermore, we will discuss the role of insulin resistance and obesity in the major metabolic tissues liver, skeletal muscle, pancreas and WAT causing the metabolic syndrome. The importance of inflammation and regulation of energy metabolism will be highlighted. The genetic risk for the metabolic syndrome overlaps with that of its major components obesity, T2D and dyslipidemia. However, like in these traits, common genetic variations can explain only a minor part of the disease risk. Therefore, we will present the important role of epigenetics in the origin and development of the metabolic syndrome.