Obesity and cardiovascular diseases
Keywords:
obesity, cardiovascular diseases, atherosclerosis, heart failure, arrhythmiaAbstract
The global obesity crisis remains a pressing issue, contributing to various cardiovascular risk factors such as dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Moreover, obesity independently escalates the risk of cardiovascular disease and related mortality. Recent findings emphasize the significance of abdominal obesity, assessed by waist circumference, as an independent marker for cardiovascular disease risk, distinct from body mass index. There have been notable advancements in characterizing body composition, including visceral adiposity, which highlight its role as a crucial factor in predicting poor cardiovascular outcomes. Lifestyle changes and subsequent weight loss can improve metabolic syndrome, systemic inflammation, and endothelial dysfunction. However, clinical trials focusing on medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, comparative studies between individuals undergoing bariatric surgery and those with obesity not undergoing surgery have shown a decreased risk of coronary artery disease with surgery. This article provides a comprehensive overview of how obesity impacts the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, including sudden cardiac death and atrial fibrillation. It also discusses the effects of lifestyle changes and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.
References
World Health Organization. Obesity and overweight [Internet]. Geneva, Switzerland; 2021. [cited December 25th, 2023]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight.
Collaborators GBDO, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med 2017;377:13-27.
Piche ME, Poirier P, Lemieux I, et al. Overview of Epidemiology and Contribution of Obesity and Body Fat Distribution to Cardiovascular Disease: An Update. Prog Cardiovasc Dis 2018;61:103-13.
Neeland IJ, Ayers CR, Rohatgi AK, et al. Associations of visceral and abdominal subcutaneous adipose tissue with markers of cardiac and metabolic risk in obese adults. Obesity 2013;21:E439-47.
Nazare JA, Smith J, Borel AL, et al. Usefulness of measuring both body mass index and waist circumference for the estimation of visceral adiposity and related cardiometabolic risk profile (from the INSPIRE ME IAA study). Am J Cardiol 2015;115:307-15.
Hiuge-Shimizu A, Kishida K, Funahashi T, et al. Absolute value of visceral fat area measured on computed tomography scans and obesity-related cardiovascular risk factors in large-scale Japanese general population (the VACATION-J study). Ann Med 2012;44:82-92.
Camhi SM, Must A, Gona PN, et al. Duration and stability of metabolically healthy obesity over 30 years. Int J Obes (Lond) 2019;43:1803-10.
Lim S, Taskinen MR, Boren J. Crosstalk between nonalcoholic fatty liver disease and cardiometabolic syndrome. Obes Rev 2019;20:599-611.
Adiels M, Olofsson SO, Taskinen MR, et al. Overproduction of very low-density lipoproteins is the hallmark of the dyslipidemia in the metabolic syndrome. Arterioscler Thromb Vasc Biol 2008;28:1225-36.
Ong KL, Ding J, McClelland RL, et al. Relationship of pericardial fat with lipoprotein distribution: The Multi-Ethnic study of atherosclerosis. Atherosclerosis 2015;241:664-70.
Shah RV, Anderson A, Ding J, et al. Pericardial, But Not Hepatic, Fat by CT Is Associated With CV Outcomes and Structure: The Multi-Ethnic Study of Atherosclerosis. JACC Cardiovasc Imaging 2017;10:1016-27.
Al-Talabany S, Mordi I, Graeme Houston J, et al. Epicardial adipose tissue is related to arterial stiffness and inflammation in patients with cardiovascular disease and type 2 diabetes. BMC Cardiovasc Disord 2018;18:31.
Cruz P, Johnson BD, Karpinski SC, et al. Validity of weight loss to estimate improvement in body composition in individuals attending a wellness center. Obesity 2011;19:2274-9.
van Gemert WA, Peeters PH, May AM, et al. Effect of diet with or without exercise on abdominal fat in postmenopausal women - a randomised trial. BMC Public Health 2019;19:174.
Coutinho T, Goel K, Correa de Sa D, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of "normal weight central obesity". J Am Coll Cardiol 2013;61:553-60.
Rao G, Powell-Wiley TM, Ancheta I, et al. Identification of obesity and cardiovascular risk in ethnically and racially diverse populations: A scientific statement from the American Heart Association. Circulation 2015;132:457-72.
Taqueti VR, Di Carli MF. Coronary microvascular disease pathogenic mechanisms and therapeutic options: JACC State-of-the-Art Review. J Am Coll Cardiol 2018;72:2625-41.
Quercioli A, Montecucco F, Pataky Z, et al. Improvement in coronary circulatory function in morbidly obese individuals after gastric bypass-induced weight loss: relation to alterations in endocannabinoids and adipocytokines. Eur Heart J 2013;34:2063-73.
Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on obesity and hear disease from the obesity committee of the council on nutrition, physical activity, and metabolism. Circulation 2006;113:898-918.
Nomura A, Zareba W, Moss AJ. Obesity does not influence electrocardiographic parameters in coronary patients. Am J Cardiol 2000;85:106-8, A9.
Bires AM, Lawson D, Wasser TE, et al. Comparison of Bruce treadmill exercise test protocols: is ramped Bruce equal or superior to standard bruce in producing clinically valid studies for patients presenting for evaluation of cardiac ischemia or arrhythmia with body mass index equal to or greater than 30? J Nucl Med Technol 2013;41:274-8.
Chow BJ, Dorbala S, Di Carli MF, et al. Prognostic value of PET myocardial perfusion imaging in obese patients. JACC Cardiovasc Imaging 2014;7:278-87.
Imai A, Komatsu S, Ohara T, et al. Visceral abdominal fat accumulation predicts the progression of noncalcified coronary plaque. Atherosclerosis 2012;222:524-9.
Motoyama S, Ito H, Sarai M, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol 2015;66:337-46.
Elagizi A, Kachur S, Lavie CJ, et al. An overview and update on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis 2018;61:142-50.
Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA 2012;307:56-65.
Reges O, Greenland P, Dicker D, et al. Association of bariatric surgery using laparoscopic banding, Roux-en-Y gastric bypass, or laparoscopic sleeve gastrectomy vs usual care obesity management with all-cause mortality. JAMA 2018;319:279-90.
Miras AD, le Roux CW. Surgery: The new gold-standard - medical gastric bypass. Nat Rev Endocrinol 2018;14:257-8.
Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 2018;378:e34.
Heffron SP, Parham JS, Pendse J, et al. Treatment of obesity in mitigating metabolic risk. Circ Res 2020;126:1646-65.
Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016;375:311-22.
Joncas SX, Poirier P, Ardilouze JL, et al. Delayed efficient anticoagulation with heparin in patients with a weight of 110 kg and more treated for acute coronary syndrome. Obesity 2013;21:1753-8.
Buschur ME, Smith D, Share D, et al. The burgeoning epidemic of morbid obesity in patients undergoing percutaneous coronary intervention: insight from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. J Am Coll Cardiol 2013;62:685-91.
Park DW, Kim YH, Yun SC, et al. Association of body mass index with major cardiovascular events and with mortality after percutaneous coronary intervention. Circ Cardiovasc Interv 2013;6:146-53.
Beavers CJ, Heron P, Smyth SS, et al, Macaulay TE. Obesity and antiplatelets-does one size fit all?. Thromb Res 2015;136:712-6.
Pankert M, Quilici J, Loundou AD, et al. Impact of obesity and the metabolic syndrome on response to clopidogrel or prasugrel and bleeding risk in patients treated after coronary stenting. Am J Cardiol 2014;113:54-9.
Oreopoulos A, Padwal R, Norris CM, et al. Effect of obesity on short- and long-term mortality postcoronary revascularization: a meta-analysis. Obesity 2008;16:442-50.
Wagner BD, Grunwald GK, Rumsfeld JS, et al. Relationship of body mass index with outcomes after coronary artery bypass graft surgery. Ann Thorac Surg 2007;84:10-6.
Totaro P. Obesity and coronary surgery: new concepts for an old problem. Expert Rev Cardiovasc Ther 2008;6:897-903.
Jehan S, Zizi F, Pandi-Perumal SR, et al. Obstructive sleep apnea and obesity: implications for public health. Sleep Med Disord 2017;1.
Pandey A, Patel KV, Vaduganathan M, et al. Physical activity, fitness, and obesity in heart failure with preserved ejection fraction. JACC Heart Fail 2018;6:975-82.
Rodriguez Flores M, Aguilar Salinas C, Piche ME, et al. Effect of bariatric surgery on heart failure. Expert Rev Cardiovasc Ther 2017;15:567-79.
Martin J, Bergeron S, Pibarot P, et al. Impact of bariatric surgery on N-terminal fragment of the prohormone brain natriuretic peptide and left ventricular diastolic function. Can J Cardiol 2013;29:969-75.
Aune D, Schlesinger S, Norat T, et al. Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol 2018;33:711-22.
Shahreyar M, Dang G, Waqas Bashir M, et al. Outcomes of in-hospital cardiopulmonary resuscitation in morbidly obese patients. JACC Clin Electrophysiol 2017;3:174-83.
Wong CX, Sullivan T, Sun MT, et al. Obesity and the risk of incident, post-operative, and post-ablation atrial fibrillation: A meta-analysis of 626,603 Individuals in 51 Studies. JACC Clin Electrophysiol 2015;1:139-52.
Tsang TS, Barnes ME, Miyasaka Y, et al. Obesity as a risk factor for the progression of paroxysmal to permanent atrial fibrillation: A longitudinal cohort study of 21 years. Eur Heart J 2008;29:2227-33.
Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation 2021;143:e984-e1010.
Beck-da-Silva L, Higginson L, Fraser M, et al. Effect of orlistat in obese patients with heart failure: a pilot study. Congest Heart Fail 2005;11:118-23.
Margulies KB, Hernandez AF, Redfield MM, et al. Effects of liraglutide on clinical stability among patients with advanced heart failure and reduced ejection fraction: A randomized clinical trial. JAMA 2016;316:500-8.
Ghosh RK, Ghosh GC, Gupta M, et al. Sodium glucose co-transporter 2 Inhibitors and heart failure. Am J Cardiol 2019;124:1790-6.
McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019;381:1995-2008.
Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol 2014;64:2222-31.
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