Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss

Abstract

Abstract-Obesity is becoming a global epidemic in both children and adults. It is associated with numerous comorbidities such as cardiovascular diseases (CVD), type 2 diabetes, hypertension, certain cancers, and sleep apnea/sleep-disordered breathing. In fact, obesity is an independent risk factor for CVD, and CVD risks have also been documented in obese children. Obesity is associated with an increased risk of morbidity and mortality as well as reduced life expectancy. Health service use and medical costs associated with obesity and related diseases have risen dramatically and are expected to continue to rise. Besides an altered metabolic profile, a variety of adaptations/alterations in cardiac structure and function occur in the individual as adipose tissue accumulates in excess amounts, even in the absence of comorbidities. Hence, obesity may affect the heart through its influence on known risk factors such as dyslipidemia, hypertension, glucose intolerance, inflammatory markers, obstructive sleep apnea/hypoventilation, and the prothrombotic state, in addition to as-yet-unrecognized mechanisms. On the whole, overweight and obesity predispose to or are associated with numerous cardiac complications such as coronary heart disease, heart failure, and sudden death because of their impact on the cardiovascular system. The pathophysiology of these entities that are linked to obesity will be discussed. However, the cardiovascular clinical evaluation of obese patients may be limited because of the morphology of the individual. In this statement, we review the available evidence of the impact of obesity on CVD with emphasis on the evaluation of cardiac structure and function in obese patients and the effect of weight loss on the cardiovascular system. (Circulation. 2006;113:898-918.)

Physical Activity, Sedentary Time, and Cardiovascular Disease Biomarkers at Age 60 to 64 Years

“…Moreover, higher adiposity, which is an established CVD risk factor,22 has also been related to an adverse biomarker profile,23 and might help explain associations between PA and CVD biomarkers24; however, to what extent adiposity mediates these associations is unclear, especially as PA and adiposity associations are still widely debated 25, 26. Additionally, among older adults, women tend to have a higher fat mass for a given body mass index than men,27 meaning it is important to study the mediating role of more direct measures of adiposity.…”

Sex Differences in Cardiovascular Disease Risk of Ghanaian‐ and Nigerian‐Born West African Immigrants in the United States: The Afro‐Cardiac Study

“…Overweight and obesity are well‐established CVD risk factors2, 44 and were the most prevalent CVD risk factors in this study. The 88% prevalence (81% of men, 93% of women) of overweight/obesity in our sample is substantially higher than the reported 68% prevalence (73% of men, 64% of women) in US adults1 and the 76% prevalence (69% of men, 82% of women) in African American adults 45.…”

Associations of Obesity With Incident Hospitalization Related to Peripheral Artery Disease and Critical Limb Ischemia in the ARIC Study

“…PAD‐related hospitalizations were identified according to the following International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD‐9‐CM ) codes based on the previous literature6, 7: atherosclerosis of native arteries of the extremities, unspecified (440.20); atherosclerosis of native arteries of the extremities with intermittent claudication (440.21); atherosclerosis of native arteries of the extremities with rest pain (440.22); atherosclerosis of native arteries of the extremities with ulceration (440.23); atherosclerosis of native arteries of the extremities with gangrene (440.24); other atherosclerosis of native arteries of the extremities (440.29); atherosclerosis of bypass graft of the extremities (440.3); atherosclerosis of other specified arteries (440.8); and leg artery revascularization (38.18, 39.25, 39.29, 39.50). Of these, 440.22, 440.23, and 440.24 were considered CLI.…”

“…Obesity has been shown to be a predictor of cardiovascular disease (CVD), including CHD, stroke, and heart failure, in a large number of previous cohort studies 6, 7, 8. Ndumele et al have also recently shown that the adjustment for obesity‐related risk factors such as diabetes mellitus, hypertension, and dyslipidemia considerably attenuates the association between obesity and CHD and stroke but not heart failure 7.…”