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Metabolic adaptation also plays a role

[] It is believed that central obesity increases the pathology of the CVD process through increased insulin resistance (IR), [,] which gives rise to a cascade of deleterious impact embracing chronic systemic inflammation, dyslipidaemia, endothelial dysfunction and an increased tendency for intravascular blood coagulation (pro-thrombotic state)

EMBO Rep (2006) 7:68893

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Mandal PK, Seiler A, Perisic T, Kolle P, Banjac Canak A, Forster H, et al