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(Hypertension. 2004;44:117.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Mediastinal Fat, Insulin Resistance, and Hypertension

From the McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada.

Correspondence to Arya M. Sharma, MD, McMaster University, Hamilton General Hospital, 237 Barton St E, Hamilton, Ontario, Canada L8L 2X2. E-mail sharma@ccc.mcmaster.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Some 250 years ago, Joannes Baptista Morgagni clearly described increased intraabdominal and mediastinal fat accumulation in android obesity.¹ Remarkably, he also recognized the association between visceral obesity, hypertension, hyperuricemia, atherosclerosis, and obstructive sleep apnea syndrome, long before the modern recognition of this syndrome.¹

Two hundred years later, the French physician Jean Vague "rediscovered" the importance of the "android" obesity phenotype and its association with diabetes, atherosclerosis, gout, and uric-acid calculous disease.² Since then, countless epidemiological and physiological studies have documented the importance of "upper body" or "abdominal" obesity as a determinant of insulin resistance, type 2 diabetes, hypertension, dyslipidemia, and cardiovascular morbidity and mortality. Together, these studies have culminated in the current concept of the "hypertriglyceridemic waistline"³ and have seen the introduction of waist circumference as a defining feature of the metabolic syndrome.

In this issue of Hypertension, Sironi et al⁴ essentially confirm the early observations of Morgagni on the relationship between intraabdominal and intrathoracic fat accumulation and hypertension using state-of-the-art MRI. Not only did newly diagnosed untreated hypertensive men have 60% more visceral and mediastinal fat than normotensive individuals, but the size of both fat depots was also positively correlated to blood pressure and inversely correlated to insulin sensitivity.

Whereas much has been written on the importance of android obesity and the role of visceral adipose tissue in the metabolic syndrome, little is known about the nature and role of mediastinal fat. Anecdotal reports have described increased mediastinal fat mass in patients with simple obesity,^5,6 and mediastino-abdominal lipomatosis . . . [Full Text of this Article]

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