Peripheral blood flow regulation in human obesity and metabolic syndrome

In conclusion, we leave the readers with four take-home points: 1) Increased sympathetically mediated vasoconstriction in addition to increases in inflammation and oxidative stress significantly impact local blood flow regulation in obese adults and adults with metabolic syndrome and may have important implications for overall vascular health early in the disease process. 2) Neither obesity nor metabolic syndrome is a homogeneous disorder, and, therefore, the quest for insight into the pathophysiology of these two conditions is challenging because of varying severities and uncertain rates of progression. 3) An array of subtle, subclinical changes likely has a big impact on vascular function but may take time to develop and require multiple insults (i.e., comorbidities) to progress to the point of obvious impairment. Thus, individuals may exhibit altered vascular control mechanisms many years before the manifestation of overt dysfunction. 4) Physical activity and other interventions focused on reducing sympathetic activity, oxidative stress, and systemic inflammation likely are effective targets that could attenuate the impact of obesity andmetabolic syndrome on the cardiovascular system and, in turn, slow the progression toward devastating effects of obesityrelated cardiovascular disease. Taken together, we are beginning to establish an emerging story where differences in blood flow, vascular heterogeneity, and individual sensitivity to subclinical changes significantly impact vascular control. These intriguing results provide ample opportunities to continue to explore the complex interplay between potentially dysfunctional mechanisms in future work.