SIGNIFICANCE: The prevalence of obesity and cardiometabolic phenotypes is alarmingly increasing across the globe and associates with atherosclerotic vascular complications and high mortality. Although multifactorial interventions, vascular residual risk remains high in this patient population, suggesting the need for breakthrough therapies. The mechanisms underpinning obesity-related vascular disease remain elusive and represent an intense area of investigation. Recent advances: Epigenetic modifications - defined as environmentally-induced chemical changes of DNA and histones which do not affect DNA sequence - are emerging as a potent modulator of gene transcription in the vasculature and might significantly contribute to the development of obesity-induced endothelial dysfunction. DNA methylation and histone posttranslational modifications cooperate to build complex epigenetic signals altering transcriptional networks implicated in redox homeostasis, mitochondrial function, vascular inflammation and perivascular fat homeostasis in patients with cardiometabolic disturbances.
CRITICAL ISSUES: Deciphering the epigenetic landscape in the vasculature is extremely challenging due to the complexity of epigenetic signals and their function in regulating transcription. An overview of the most important epigenetic pathways is required to identify potential molecular targets to treat or prevent obesity-related endothelial dysfunction and atherosclerotic disease. This would enable the employment of precision medicine approaches in this setting.
FUTURE DIRECTIONS: Current and future research efforts in this field entail a better definition of the vascular epigenome in obese patients as well as the unveiling of novel, cell-specific chromatin-modifying drugs able to erase specific epigenetic signals responsible for maladaptive transcriptional alterations and vascular dysfunction in obese patients.