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Obesity, the Metabolic Syndrome, and Pulmonary Hypertension

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Book cover Obesity and Lung Disease

Part of the book series: Respiratory Medicine ((RM,volume 19))

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Abstract

Pulmonary hypertension may be caused by many different conditions, classified broadly into five categories by the World Health Organization. The primary determinants of pulmonary vascular pressure are left atrial pressure, pulmonary vascular resistance, and flow through the pulmonary circulation. In this chapter, the effects of obesity on each of these components are considered. Currently, there is ample evidence that obesity and its attendant systemic diseases play a role in increasing left atrial pressure and may affect flow through the pulmonary vasculature. Hypoxia is a potent pulmonary vasoconstrictor, and increased pulmonary vascular resistance is well described in patients with hypoxemia associated with sleep-disordered breathing or obesity hypoventilation. There is also a growing body of literature that fat cytokines such as adiponectin and insulin resistance associated with obesity may contribute to the development of primary pulmonary vascular disease such as pulmonary arterial hypertension. In addition to examining the role obesity may play in pulmonary hypertension etiology, this chapter will review the difficulty obesity poses to accurately diagnosing pulmonary vascular disease and the role of obesity in pulmonary hypertension therapy.

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Abbreviations

BMI:

Body mass index

BMPR2:

Bone morphogenic protein receptor type 2

COPD:

Chronic obstructive pulmonary disease

HFPEF:

Heart failure with preserved ejection fraction

NHANES:

National health and nutrition examination survey

OHS:

Obesity hypoventilation syndrome

OSA:

Obstructive sleep apnea

PPARγ:

Peroxisome proliferator-activated receptor γ

PAH:

Pulmonary arterial hypertension

PH:

Pulmonary hypertension

PVH:

Pulmonary venous hypertension

RHC:

Right heart catheterization

WHO:

World health organization

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Authors and Affiliations

  1. Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South MCN, Room T-1218, Nashville, TN, 37232, USA

    Anna Ryan Hemnes M.D. & Ivan M. Robbins M.D.

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  1. Anna Ryan Hemnes M.D.
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  2. Ivan M. Robbins M.D.
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Correspondence to Anna Ryan Hemnes M.D. .

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Editors and Affiliations

  1. , Pulmonary and Critical Care Medicine, University of Vermont College of Medicin, 89 Beaumont Ave., Burlington, 05405, Vermont, USA

    Anne E. Dixon

  2. , Clinical Development Medical Affairs, Respiratory Boehringer Ingelheim Pharmac, N/A, Ridgefield, 06877, Connecticut, USA

    Emmanuelle M. Clerisme-Beaty

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Hemnes, A.R., Robbins, I.M. (2013). Obesity, the Metabolic Syndrome, and Pulmonary Hypertension. In: Dixon, A., Clerisme-Beaty, E. (eds) Obesity and Lung Disease. Respiratory Medicine, vol 19. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-053-3_9

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