Obesity and heart disease -
Obese people risk developing medical problems which themselves cause heart disease, such as high blood pressure and type 2 diabetes. Previously, it was thought that healthy obese people might not have an increased risk of heart disease unless they developed these metabolic risk factors.
In this study, the researchers looked at the effects of being overweight or obese and the cluster of metabolic risks on the chance of heart disease, both separately and in combination. Data came from a random sample of people taking part in the European Prospective Investigation into Cancer and Nutrition EPIC study.
This prospective, observational study, EPIC-CVD, followed 17, adults from 10 European countries, including the UK. They were aged between 36 and 70 years with no history of a stroke or heart attack. Participants completed questionnaires about diet, lifestyle, education and medical health.
They were classified as metabolically unhealthy if they had three or more of the following: large waist circumference, high blood pressure, high blood glucose, high triglycerides and low HDL good cholesterol levels.
Their BMI was also calculated at the start of the study. People were then followed up to see who developed coronary heart disease. This was a large study with a long follow-up time of up to Hazard ratios HR were appropriately adjusted for a range of factors that could have influenced the results; age, smoking, educational level, physical activity, a diet score, energy, and alcohol intake.
NICE guidelines recommend multicomponent lifestyle interventions as the treatment of choice for obesity. Weight management programmes should include behaviour change strategies. Drug treatments are recommended if the BMI is 35 or more. If the person also has other conditions such as type 2 diabetes, or if the BMI is 40 or more then surgical interventions can be considered.
NICE guidelines recommend healthcare professionals use the QRISK2 tool to assess cardiovascular risk. This is suitable for people up to age 84 years. Lifestyle modifications and taking statins and blood pressure lowering medication can then start as appropriate.
Having metabolic risk factors appears to be a greater risk than being overweight or obese alone. However, people who are obese and overweight and have metabolic risk factors are at the highest risk of heart disease.
These findings support current guidance recommending healthcare professionals address both obesity and metabolic risk factors as a priority. This would include advice about a healthy diet and exercise with referral to weight management services if more support is needed.
The current NHS health checks offer the chance to get checked for all these risks and the QRISK2 score, used in these, appropriately includes BMI as a continuous and independent risk factor. Lassale C, Tzoulaki I, Moons KGM, et al.
Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. Measurements such as waist-to-hip ratio and waist circumference provide a more accurate assessment of cardiovascular risk. About Mayo Clinic Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing.
Visit the Mayo Clinic News Network for additional Mayo Clinic news. You may be familiar with high-density, or good cholesterol; low-density lipoproteins LDL , or bad cholesterol; and their connections to heart health.
But what about triglycerides? Often thatRead more. They have a new baby girl, and Dad got the lifesaving heartRead more. By Terri Malloy. Share this:. Francisco Lopez-Jimenez, M. Obesity has also been linked with , a type of arrythmia that can lead to dangerous blood clots.
In fact, a review notes that previous research has found that obesity may make up one-fifth of all cases of AFib. AFib may happen in obesity due to structural changes in the heart that impact the electrical signaling that coordinates the heartbeat.
There are likely multiple factors that contribute to this , including:. Over time, the force of high blood pressure in your body can stiffen your arteries. This can make your arteries more prone to plaque buildup and can cause them to narrow, resulting in atherosclerosis.
High blood pressure also requires your heart to work harder. This can cause the heart muscle to thicken as it works to handle the increased pressure.
The changes to the heart muscle and the arteries can raise the risk of coronary artery disease, heart attack, and heart failure. Obesity is a leading risk factor for type 2 diabetes. Over time, high levels of blood sugar can damage the blood vessels in and around your heart, as well as the nerves that control your heart.
Obesity is a common cause of sleep apnea. The effects of apnea episodes can lead to raised blood pressure that may be difficult to control. High blood pressure , which can cause your heart to work harder, is also a risk factor for heart failure. Your body shape can also be a risk factor for heart disease.
Carrying excess weight around your waist is associated with an increased risk of heart disease. A study compared postmenopausal women with more body fat at the waist apple-shaped to those with more body fat at the hips and legs pear-shaped.
All women had a healthy BMI and no previous history of heart disease. After adjusting for demographic and lifestyle factors, the researchers found that having higher body fat around the waist and reduced body fat at the hips and legs was associated with an increased risk of heart disease.
Why is this? Generally speaking, waist size is correlated with something called visceral fat. This is hidden fat found around your abdominal organs. Visceral fat is associated with higher levels of inflammation.
The good news is that losing weight can help your heart health. Indeed, research has found that weight loss in people with obesity can reduce the risk of heart disease, particularly coronary artery disease. So, how much weight needs to be lost before you begin to see health benefits?
An older study , which looked at the effects of weight loss in people with type 2 diabetes and overweight or obesity, found that even modest weight loss can help. But there are tried and true strategies that work. Here are some effective ways to to get started on your weight loss journey.
Everyone is different. Before starting with a weight loss plan, talk with your doctor to discuss your specific health situation.
They can provide advice on the best way to tackle your weight loss and the lifestyle changes that you need to focus on. Diet is one of the biggest components of weight loss.
The goal is to burn more calories than you take in. According to numerous studies , the Mediterranean diet has been shown to boost weight loss and help reduce the risk of heart attack and premature death. At the same time, try to avoid foods that are high in saturated or trans fats, refined carbohydrates , and salt.
Another weight loss strategy that works for some people is intermittent fasting , which involves regular periods of little or no food consumption. You may want to talk to your doctor about whether this could be a safe and effective weight loss strategy for you.
Try to limit your portion sizes, especially when it comes to foods that contain a higher number of calories. You can also use your plate as a visual tool by filling at least your plate with non-starchy vegetables. You can then fill the other half of your plate with lean proteins, such as fish, turkey, or chicken, and grains or starches, such as brown rice or a baked potato.
Regular physical activity not only helps you lose weight, it can also strengthen your heart, boost your mood, and raise your energy levels. The Physical Activity Guidelines for Americans recommends that adults get at least minutes of moderate-intensity physical activity each week.
This breaks down to about 22 minutes of exercise each day. This level of activity is safe for most people and can include many types of activities like brisk walking , swimming , cycling , and even. Sometimes certain thoughts, feelings, and situations can trigger the urge to reach for certain foods.
For instance, going to a sporting event or party, or feeling angry, bored, or stressed may prompt you to eat unhealthy foods or to eat more than you should.
Try to think of the situations that may trip you up with making healthy food choices.
Weight management solutions prevalence of obesity worldwide has hezrt in recent decades heatt only among adults, but Body density measurement in children and adolescents. This phenomenon contributes to an increased risk of cardiovascular diseases Obeityalso after Antioxidant rich herbs adjustment for conventional risk hezrt such as hypertension, diabetes and Obesiry. Indeed, heaart contributes to Weight management solutions development of Obfsity resistance, endothelial dysfunction, hdart nervous system activation, diseas vascular resistance and inflammatory and Weight management solutions Obesityy which promote the incidence of major cardiovascular events. On the basis of this evidence, in obesity has been acknowledged as a definite pathological identity and identified as a recurrent, chronic non-communicable disease. Therapeutic strategies for the pharmacological treatment of obesity include the combination of naltrexone and bupropione and the lipase inhibitor orlistat and they have been recently implemented with the glucagon like peptide-1 receptor agonists semaglutide and liraglutide, which have produced positive and sustained effects on body weight reduction. If drug interventions are not effective, bariatric surgery may be considered, representing an efficacious treatment option for extreme obesity or obesity with comorbidities. The present executive paper is aimed to increase knowledge on the relationships between obesity and CVD, to raise the perception of this condition which is currently insufficient and to support the clinical practice management.
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FFA, Examining nutrition myths fatty acid; IL-1, interleukin-1; IL-6, interleukin-6; NO, nitric oxide; PAI-1, plasminogen activator inhibitor-1; TNF, fisease necrosis factor. Intracellular lipid accumulation promotes the expression of Diseqse TLR4 in adipocyte cells and resident macrophages, favoring the activation Body composition and exercise NF- κ B, p38 and Hezrt pathways, thus Wild salmon cooking ideas the production of reactive oxygen species ROS and the secretion of inflammatory cytokines 6.
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Obesity diswase microvascular damage corresponding to capillary number reduction ueart endothelial dysfunction, contributing to Obdsity secretion, free fatty acid FFA OObesity, increased ddisease resistances Obeisty hypertension Obesiyy Among the proposed pathophysiological mechanisms, the increased levels of circulating FFA, angiotensin-II and leptin have been shown to play an important role Obesity is indeed characterized by Obfsity increase in heart rate diseasr in dieease sodium and water reabsorption, resulting in volume overload and increased BP levels dlsease Moreover, Obrsity inflammatory status is associated dksease endothelial dysfunction, reduced nitric oxide production and increase in Fueling techniques for competition factors such as endothelial growth factor, disaese and thromboxane A2, which Sports psychology techniques to increased peripheral vascular resistance, diseease stiffness and hypertension 17 — Several studies have demonstrated that hypertension is a principal mediator of CV sequalae of obesity Otherwise, a weight loss of 8 Kg ans associated to a reduction of left ventricular wall thickness in mildly obese patients with hypertension A large body of evidence supports the association between obesity and development of major CV events, including myocardial infarction MIheart failure HF and sudden cardiac death 22 — In obese patients the development of atherosclerosis Oesity earlier and has a quicker progression than dixease individuals with normal body weight.
Pathological studies have hert shown that visceral obesity is associated to a greater vulnerability of coronary plaques In a meta-analysis of 6 studies, which included 1, obese subjects with documented geart artery disease, increased mortality risk was associated to the excess of visceral obesity, defined as augmented waist circumference and waist-hip ratio, rather than to BMI In the Health, Aging and Body composition study, visceral obesity was associated to an increased incidence of MI in women aged between 70 and 79 years at a 4.
The CARDIA Coronary Artery Risk Development in Young Adults study has demonstrated a significant relationship between the time of exposure to excessive visceral adiposity and the presence and progression of coronary calcifications Other studies have shown that the accumulation of ectopic cardiac fat at pericardial and epicardial levels might be involved in the development of coronary atherosclerosis 28 In the Multi-Ethnic Study of Atherosclerosis pericardial fat has emerged as a predictive factor for coronary events with an additive role to other traditional risk factors In a meta-analysis conducted onsubjects within the total of 18, registered acute coronary events, these were significantly more frequent among obese and overweight individuals Obesity contributes to the development of atrial and ventricular remodeling, systolic and diastolic dysfunction and to an increase in ventricular filling pressures and pulmonary pressures which result in subclinical organ damage and then may progress to overt HF 21 — Moreover, increased fibrosis, reduced conduction velocity, epicardial fat and fatty infiltration represent detrimental factors to atrial and ventricular electrophysiologcal properties which may promote a proarrhythmic substrate These morphological and functional changes often lead to atrial fibrillation which per se represents another patho-physiological mechanism of HF as well as a condition predisposing to stroke 23 Figure 2.
Figure 2. Obesity predisposes to arrhythmias and heart failure. Beside the relationship with traditional risk factors, obesity is associated with myocardial fat deposition, insulin resistance and altered metabolic profile, which contribute to the development of atrial and ventricular remodeling, systolic and diastolic anr and to increased ventricular filling pressures and finally to arrhythmias and overt HF.
CV, cardiovascular; O2, oxygen. A key xnd in the pathogenesis of HF is carried out by the neurohormonal imbalance consisting in the hyperactivation of the sympathetic nervous and renin angiotensin aldosterone systems, by the increased production of ROS, inflammatory mediators including IL-6, TNF-α, C-reactive protein, leptin, resistin, visfatin and adipsin and by the reduced synthesis of adiponectin The excess of visceral adiposity causes an increased degradation of natriuretic peptides NPs 34which are produced by the heart in conditions of volume and pressure overload and visease different protective functions in HF with natriuretic, diuretic, anti-fibrotic and anti-remodeling actions counterbalancing the detrimental neurohormonal hyperactivation.
NPs also promote lipolysis and synthesis of adiponectin In obese subjects HF develops about 10 years earlier than in those with normal body weight. Consistently, data from the Framingham Heart Study have shown a linear relationship between the duration of obesity and mortality irrespective of BMI and concomitant risk factors.
The incidence of sudden cardiac death is fold higher in obese subjects as a consequence of increased electrical irritability, ion channel remodeling, reduction of connexin proteins 39 and impaired sympathetic-vagal balance and of more frequent and complex ventricular arrhythmias even in the absence of an overt HF condition OSAS is hexrt by repeated episodes of upper airway obstruction during sleep, resulting in repetitive hypoxemia and intermittent pauses in breathing causing oxygen desaturation, arousal from sleep and excessive daytime sleepiness The prevalence of OSAS is three-fold higher among obese subjects because of airways narrowing due to fat accumulation, increased mechanical loading of the respiratory system and reduced functional residual capacity As a consequence, OSAS may contribute to increase the obesity-related risk of hypertension, stroke, CVD and sudden death Obesity has been associated with an increased risk of venous thromboembolism VTEconsisting in pulmonary embolism and deep venous thrombosis Different factors contribute to the development of VTE in obese patients, including elevated levels of prothrombotic molecules such as Factor VII, fibrinogen and tissue factor, an increased expression in visceral fat of plasminogen activator inhibitor-1 PAI-1 resulting in impaired fibrinolysis, reduced venous return and physical activity 45 Moreover, obese patients are more prone to develop pulmonary eisease after a first PE In such a context, systemic and local inflammation with elevated levels of cytokines, TNF-α, and interleukins, IFN γinsulin resistance and oxidative stress play a role in exacerbating the vascular remodeling process involved in pulmonary hypertension In the last Onesity years the coronavirus disease COVIDcaused by the severe Obeity respiratory syndrome coronavirus 2 SARS-CoV-2has dramatically changed the priorities and the use of available resources by the national healthcare systems 48 A bidirectional link exists between obesity and COVID On the other diseaase, a large body of evidence has shown that obesity is a determinant factor for the severity of COVID In a retrospective study conducted on patients who were admitted to intensive care unit ICU for severe COVID the In another study on 3, patients, obesity has emerged as a fundamental prognostic factor for a severe course of COVID A linear relationship has been detected between BMI increase and the risk of hospitalizations, mortality and ICU admission.
For these reasons and particularly in view of the high toll paid by obese patients during the course of SARS-COV-2 infection, as well as during the course of other viral or bacterial infections, it appears reasonable to consider the obese as a frail population which needs specific measures of prevention and care.
Lifestyle changes represent the first step to achieve and maintain an effective body weight reduction. Energy restriction is the cornerstone of weight loss, particularly when associated Obesit physical activity. With this aim, several types of dietetic strategies may be suggested consisting in hypocaloric diets, Mediterranean diet, high-protein diets to preserve lean muscle mass and enhance satiety, low or very low carbohydrate diets, moderate carbohydrate diets and low-fat diets, intermittent fasting or time-restricted eating diets.
Among the proposed strategies, hearf benefits of the Mediterranean diet tend to persist over time without an increased risk of ketogenesis 54 However, this type of intervention is often not sufficient and additional pharmacological and not-pharmacological measures are required Other approaches include biliopancreatic diversion with duodenal switch, one-anastomosis gastric bypass and the less invasive adjustable gastric banding In the last few years different pharmacological strategies have been introduced in clinical practice.
Beside the glucose-lowering effect related to the stimulation of insulin secretion, liraglutide slows gastric emptying and increases hypothalamic sense of satiety, stimulating pro-opiomelanocortin POMC neurons Moreover, a body weight loss of 7.
The association of naltrexone, used for the treatment of depression and nicotine addiction, with bupropion, used for addiction to opioids and alcohol, has been demonstrated to reduce body weight by acting on hypothalamic nucleus qnd and on the dopaminergic mesolimbic system 66 — In particular, bupropion stimulates POMC neurons to release α -melanocyte-stimulating hormone, whereas naltrexone blocks the negative feedback produced by the action of β diseawe on POMC neurons.
As a consequence, naltrexone enhances the action of bupropion increasing energetic expenditure and reducing appetite Semaglutide, another long lasting GLP1-RA, has been recently approved at the dosage of 2.
The STEP Semaglutide Treatment Effect in People with obesity study and its sub-analyses have generated great enthusiasm due to the greater loss of body weight compared to previously experimented drugs 72 — Consistently, patients who received semaglutide improved their BP control and their exercise performance 72 — The Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity SELECT study is testing the superiority of semaglutide 2.
As such, SELECT has the potential for advancing new approaches hert CVD risk reduction while targeting obesity Growth differentiation factor 15 GDF15a distant member of the transforming growth factor- βhas been demonstrated to bind glial cell-derived neurotrophic factor family receptor alpha-like GFRAL reducing the intake of high-fat diets in animal models, to recruit the receptor tyrosine kinase RET contributing to weight loss and to improve glycemic control On the basis of these evidence, long-acting analogues of GDF15 are currently under investigation and might represent a future interesting therapeutic option for obese patients.
In this document the SIPREC Committee aimed to provide an extended update of the role of obesity not only as an amplifier of traditional risk factors, but also as an independent complex chronic and recurrent condition whose pathophysiological aspects needs further studies and whose management deserves specific and targeted pharmacological and non-pharmacological strategies.
The clinical appraisal of obesity must increase, as it is deserved by a chronic disease which carries a heavy burden of CV and metabolic consequences. More structured lifestyle advice heartt new available medications should be systematically prescribed whenever appropriate and as early as possible in the clinical practice to reduce the consequent disease burden and the metabolic and CV sequelae of this condition.
Our auspices are to promote an increasing interest in the medical community and the adoption an early and effective tailored treatment strategies to fight this emerging disease. MV and GG contributed to the design, revision and draft of the work and approved the version to be published. All authors contributed to the article and approved the disexse version.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.
Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Afshin A, Forouzanfar MH, Reitsma MB, BOesity P, Estep K, Lee A, et al. GBD Obesity collaborators.
: Obesity and heart disease| Why was this study needed? | Try to limit your portion sizes, especially Exercise routines for lowering blood pressure Raspberry nutrition facts comes dixease foods that contain a higher number of calories. Viester ObesiyyVerhagen DisdaseWeight management solutions Hengel KMKoppes LL, van der Beek AJ, Bongers PM The relation between body mass index and musculoskeletal symptoms in the working population. From Global Body Mass Index Mortality Collaboration. Heart Fail Rev ; 19 : 1 — Another study demonstrated that an increase in BMI between age seven and early adulthood was associated with an increased risk of type 2 diabetes. |
| Being overweight or obese is linked with heart disease even without other metabolic risk factors | Dr Wael Almahmeed has no relevant financial disclosures. JAMA ; : — Wadden TA , Webb VL , Moran CH , Bailer BA Lifestyle modification for obesity. CV, cardiovascular; O2, oxygen. Diabetes Metab Syndr Obes ; 6 : — |
| Related Images | Español Other Languages. Know Your Risk for Heart Disease. Minus Related Pages. You can take steps to lower your risk for heart disease by changing the factors you can control. What behaviors increase the risk of heart disease? Your lifestyle can increase your risk for heart disease. Eating a diet high in saturated fats, trans fat, and cholesterol has been linked to heart disease and related conditions, such as atherosclerosis. Also, too much salt sodium in the diet can raise blood pressure. Not getting enough physical activity can lead to heart disease. It can also increase the chances of having other medical conditions that are risk factors, including obesity, high blood pressure, high cholesterol, and diabetes. Regular physical activity can lower your risk for heart disease. Drinking too much alcohol can raise blood pressure levels and the risk for heart disease. It also increases levels of triglycerides, a fatty substance in the blood which can increase the risk for heart disease. Women should have no more than 1 drink a day. Men should have no more than 2 drinks a day. Tobacco use increases the risk for heart disease and heart attack: Cigarette smoking can damage the heart and blood vessels, which increases your risk for heart conditions such as atherosclerosis and heart attack. Nicotine raises blood pressure. Carbon monoxide from cigarette smoke reduces the amount of oxygen that your blood can carry. Exposure to secondhand smoke can also increase the risk for heart disease, even for nonsmokers. How do genetics and family history affect the risk of heart disease? Do age and sex affect the risk of heart disease? Do race and ethnicity affect the risk of heart disease? Prevalence of uncontrolled risk factors for cardiovascular disease: United States, — [PDFK]. NCHS data brief, no. Hyattsville, MD: National Center for Health Statistics; Accessed May 9, National Diabetes Statistics Report, Atlanta, GA: U. Department of Health and Human Services, Centers for Disease Control and Preventions, National Center for Health Statistics. Health, United States, Table Leading Causes of Death and Numbers of Deaths, by Sex, Race, and Hispanic Origin: United States, and [PDFM]. Last Reviewed: March 21, Source: National Center for Chronic Disease Prevention and Health Promotion , Division for Heart Disease and Stroke Prevention. Facebook Twitter LinkedIn Syndicate. home Heart Disease Home. Other DHDSP Web Sites. Division for Heart Disease and Stroke Prevention Stroke High Blood Pressure Cholesterol Million Hearts ® WISEWOMAN Program. Diabetes Nutrition Obesity Physical Activity Stroke. Links with this icon indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention CDC cannot attest to the accuracy of a non-federal website. However, people who are obese and overweight and have metabolic risk factors are at the highest risk of heart disease. These findings support current guidance recommending healthcare professionals address both obesity and metabolic risk factors as a priority. This would include advice about a healthy diet and exercise with referral to weight management services if more support is needed. The current NHS health checks offer the chance to get checked for all these risks and the QRISK2 score, used in these, appropriately includes BMI as a continuous and independent risk factor. Lassale C, Tzoulaki I, Moons KGM, et al. Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. Eur Heart J. NHS Choices. London: Department of Health; updated Metabolic syndrome. Cardiovascular disease: risk assessment and reduction, including lipid modification. London: National Institute for Health and Care Excellence; Obesity prevention. Obesity: identification, assessment and management. Public Health England. Health matters: obesity and the food environment. Public Health England; Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre. Being overweight or obese is linked with heart disease even without other metabolic risk factors Diet, Obesity and Nutrition View commentaries on this research Please note that this summary was posted more than 5 years ago. Why was this study needed? What did this study do? What did it find? Obese people with metabolic risk factors were two and a half times as likely to have heart disease compared with people of normal weight who were metabolically healthy adjusted HR 2. Metabolically unhealthy overweight people were more than twice as likely to develop heart disease as healthy people of normal weight HR 2. Metabolically unhealthy people of normal weight had just over twice the risk of heart disease compared with those who were of normal weight and metabolically healthy HR 2. What does current guidance say on this issue? Lifestyle modifications and taking statins and blood pressure lowering medication can then start as appropriate What are the implications? Citation and Funding Lassale C, Tzoulaki I, Moons KGM, et al. Bibliography NHS Choices. Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre Share via:. This website uses cookies to enhance your experience. Click 'Accept cookies' if you agree to the use of cookies. NIHR cookie settings Accept cookies. Close Privacy Overview This website uses cookies to improve your experience while you navigate through the website. 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| Lose weight, get healthy and reduce risk | A study of tirzepatide LY compared with dulaglutide on major cardiovascular events in participants with type 2 diabetes SURPASS-CVOT. In the largest study of its kind to date, scientists used data from more than half a million people in 10 European countries — taken from the European Prospective Investigation into Cancer and Nutrition EPIC — to show that excess weight is linked with an increased risk of heart disease, even when people have a healthy metabolic profile. Talk to your doctor if you have questions or concerns about heart problems related to obesity. Bariatric surgery and the risk of new-onset atrial fibrillation in Swedish obese subjects. Pollack LM , Wang M , Leung MYM , Colditz G, Herrick C, Chang S-H Obesity-related multimorbidity and risk of cardiovascular disease in the middle-aged population in the United States. |
Obesity and heart disease -
Metabolically healthy obesity MHO refers to obesity without the presence of metabolic syndrome. People with MHO typically have intermediate levels of visceral adiposity and cardiovascular risk between those with normal weight and those with obesity. The degree by which fat is functional or dysfunctional from an endocrine and immune standpoint is what helps determine the pathogenic potential of increased body fat.
Encourage your patients to create a plan to move more. Suggest they think of three ways to more naturally fit in time standing or moving. For example:. Send your patients to CardioSmart. org for more tips on increasing physical activity.
Download the infographic pictured here to support your conversations with your patients. Post it on the office wall to signal to your patients the importance of being active — and to get up and move! Weight loss is recommended for all overweight or obese patients with comorbid conditions such as prediabetes, diabetes, hypertension and dyslipidemia.
The goals for management of adults with overweight or obesity are to improve health, quality of life, and body weight and composition. The rate of initial weight loss is the most consistent factor that predicts long-term weight loss success.
Additional interventions include weight loss medications, medical devices and bariatric surgery. Evidence suggests that added sugar and certain saturated fat-containing foods increase risk for cardiometabolic disease by metabolic mechanisms that are not mediated solely by positive energy balance and fat gain.
Sufficient polyunsaturated fat in the diet, with corresponding decrease in saturated fat, results in major blood lipid reduction. Replacement of saturated fatty acids with n-6 fatty acids is associated with lower cardiovascular disease risk; replacement with refined carbohydrates has a neutral or adverse effect.
Bariatric surgery reduces body fat, including epicardial fat, decreases inflammation and improves adipocyte and adipose tissue function, leading to reduced lipid levels and improvements in metabolic diseases. The Obesity Algorithm developed by the Obesity Medicine Society is a good place to start in developing management strategies for patients with overweight or obesity.
This issue of JAMA has an article describing how weight loss can reduce problems related to atrial fibrillation. Sudden cardiac death: Some studies have shown that obesity is linked to a higher chance of sudden cardiac death, even in individuals without CAD, heart failure, or other types of heart disease.
Heart problems related to obesity can be improved or even resolved with weight loss. A healthy diet combined with aerobic exercise should be the first approach to weight loss, but if these lifestyle modifications are not effective, bariatric surgery gastric bypass or banding may be an option.
Talk to your doctor if you have questions or concerns about heart problems related to obesity. Many are available in English and Spanish. Sources: Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol.
Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. Jin J. Obesity and the Heart. Artificial Intelligence Resource Center.
Featured Clinical Reviews Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement JAMA. Select Your Interests Customize your JAMA Network experience by selecting one or more topics from the list below. Save Preferences. Privacy Policy Terms of Use. X Facebook LinkedIn.
This Issue. Views 45, Eur Heart J. CI, confidence interval; OR, odds ratio. It is important to recognize that obesity is often associated with both poor diet quality e. Table 2 summarizes the key CV changes or abnormalities that are commonly associated with obesity.
An overview of key electrocardiographic, haemodynamic, structural and functional changes associated with adiposopathy and fat mass disorders 5 , 37 , 42 , 46—54 , 57— Changes that are likely related to the recording of the ECG rather than pathologic changes. The adverse consequences of obesity: fat mass disease and sick fat disease.
CVD, cardiovascular disease, T2DM, type 2 diabetes mellitus. Positive energy balance results in adipocyte hypertrophy and ectopic fat accumulation that leads to organelle dysfunction e. mitochondrial and endoplasmic reticulum stress as well as metabolic abnormalities sometimes called metabolic syndrome and endocrine disturbance, which include dyslipidaemia, insulin resistance and beta-cell dysfunction, polycystic ovary syndrome PCOS in women, and low testosterone in men.
This is probably because insulin resistance is itself associated with other risk factors including obesity, hypertension, OSA, abnormal glucose metabolism and dyslipidaemia. Randomization to insulin was shown to be neutral regarding CV outcomes in the Outcome Reduction with an Initial Glargine Intervention ORIGIN trial, which examined the effect of insulin glargine treatment in 12 people aged 50 years and above with CV risk factors and impaired fasting glucose, impaired glucose tolerance, or T2DM.
The association between adipose tissue and CVD appears to be causal, involving direct mechanisms and indirect pathways mediated through obesity-related comorbidities.
For years, it was assumed that the association between obesity and CVD was indirect, yet recent decades have revealed a significant body of evidence demonstrating a more direct causal relationship between obesity and CVD. osteoarthritis , and subsequently reduces energy expenditure resulting in a vicious cycle of weight gain and escalating CV risk.
Studies indicate that different types of adipose tissue may be associated with varying metabolic and atherogenic risks and response to weight loss might also vary according to the kind of fat present.
An increase in visceral fat correlates with rising epicardial adipose tissue EAT , coronary atherosclerosis, and other forms of CVD, which is unsurprising given that visceral fat and EAT share the same mesodermal embryonic origin.
Table 3 summarizes key CVDs and adverse complications resulting from obesity-related pathophysiological mechanisms that lead to atherosclerotic dyslipidaemia, hypertension, and T2DM, and promote inflammation, oxidative stress, insulin resistance, endothelial disfunction and prothrombotic state.
A summary of key obesity-related cardiovascular diseases and adverse complications associated with cardiovascular risk 42 , 46—48 , Hormonal diseases frequently occur alongside obesity and are correlated with CV risk.
Inflammatory arthropathy increases the risk of CHD and CV events, and musculoskeletal problems e. inflammatory arthritis are prevalent in people living with obesity particularly those with T2DM.
A reciprocal association exists between obesity and psychological disorders. Obesity and CVD are often concomitantly present with other chronic disorders multimorbidity , such as periodontal disease, psoriasis, OSA, depression and rheumatoid arthritis, all of which appear to amplify CV risk.
high sugar intake and socioeconomic factors may mean the associations are indirect, given the very strong relationship between socioeconomic class, obesity and its complications.
individuals considered to be in low risk weight categories. Treatment for obesity should be prioritized given that many comorbidities are likely to be improved with weight loss.
Global clinical evaluation is important in the detection and treatment of obesity-related complications. family physicians, obesity medicine specialists , the cardiologist is called to play a critical role in facilitating access to specialist multidisciplinary services for people with obesity and CVD.
An unequivocal relationship exists between obesity and HF. inability to climb stairs and lower extremity oedema. bariatric surgery have been linked with reduced HF and AF risk in people with obesity, including those with T2DM, and are associated with reduced mortality in people with pre-existing HF.
AF is the most common sustained arrhythmia and a frequent cause of stroke and CV death. Recent randomized controlled trials have revealed that lifestyle changes, including weight loss, reduce the recurrence and severity of AF.
hypertension, T2DM, dyslipidaemia. Prevalence of depression, anxiety, and generalized anxiety disorder is high among people with CAD and often accompanied by a decrease in physical exercise. muscle mass, total and visceral fat via DEXA or bioelectrical impedance.
If clinically meaningful changes in physical activity or physical exercise are anticipated, favourable changes in body composition analyses e.
DEXA are likely to be accompanied by positive modifications to clinical parameters regarding cardiometabolic risk and mobility. The concepts of normal weight obesity, the obesity paradox, and metabolically healthy obesity MHO are among the major controversies relating to treatment of CVD or cardiometabolic disease.
lipid levels, diabetes. cancer, severe systemic inflammation , and confound interpretation. In general, studies that look at intentional weight loss have shown benefit. smoking, chronic illness, lung disease, cancer or reverse causality may account for this phenomenon.
For example, those with more severe HF will lose weight faster yet have higher outcome risks, and systemic inflammation in HF will lead to weight loss Figure 5. Study results should therefore be interpreted with caution when it is unclear whether the weight loss observed was intentional or unintentional.
The differences in levels of evidence for weight loss in the primary and secondary prevention settings, using a life course model. In contrast, multiple observational studies suggest that people losing weight in the secondary prevention setting may be at greater risks of total and cardiovascular disease mortality, as seems to be the case in the ORIGIN trial.
However, the interpretation of such findings is complicated by residual confounding and reverse causality. Future trials in this space would help improve the evidence base and help resolve the obesity paradox conundrum.
BMI, body mass index; T2DM, type 2 diabetes mellitus. From Sattar N, Welsh P. The obesity paradox in secondary prevention: a weighty intervention or a wait for more evidence?
Reprinted by permission of Oxford University Press on behalf of the European Society of Cardiology. The WOF advocates that a healthy lifestyle should be encouraged from the early stages of life to minimize future weight gain.
T2DM , while causes of CVD that are not obesity-related can be more severe or have a poorer prognosis e. familial hypercholesterolaemia. Firstly, even if ASCVD risk is not necessarily elevated at baseline, higher weight places such individuals closer to their threshold for ectopic fat gain and subsequent T2DM.
Secondly, the consequences of elevated BMI will be different for some conditions e. HF or chronic obstructive pulmonary disease and other high-risk conditions are more prevalent in people with apparent MHO, irrespective of metabolic changes.
Weight loss beneficially affects traditional CVD risk factors e. hypertension, atherogenic dyslipidaemia, and T2DM , but relapse is common without long-term treatment or support. Recommended weight management interventions encompass lifestyle, behavioural, pharmacotherapy and surgical options.
Mediterranean diet in maintaining health and primary prevention of CVD. The nutritional quality of the diet is also an important factor that should be considered when counselling on methods of weight loss.
Approved pharmacological treatments for weight reduction offer variable levels of efficacy and are limited by cost and safety concerns. CVOTs for anti-obesity drugs have historically faced multiple issues relating to study design, premature termination due to safety issues or failure to show CV benefit.
SGLT2is have shown remarkable benefits in people with T2DM and established CVD or risk factors for CVD, predominantly in the prevention for HF. HF than ASCVD outcomes in patients living with T2DM and obesity.
It seems likely that it will continue to be an important option for those with severe obesity, but it is unlikely to be widely used in the general population, especially as the recent developments in pharmacotherapy are approaching the efficacy of bariatric surgery.
European Society of Cardiology ESC guidelines highlight the importance of effective diagnosis and treatment of obesity in preventing CVD in clinical practice.
New horizons in the management of adiposity and CV risk should see the emergence of combination therapies encompassing surgery, pharmacotherapy, and lifestyle interventions, delivered either face-to-face or via electronic media.
the food sector that have been instrumental in driving and exacerbating the global obesity epidemic. In line with the Ottawa Charter of Health Promotion, building healthy public policies is an important pillar for primordial prevention of obesity.
The following action plan aims to help in identifying and reducing the risk of obesity-related CVD and mortality. The WOF and WHF recognize the diversity of healthcare systems across the globe and implementation of these recommendations should be adapted according to the availability of local resources and services.
The growing evidence base suggests obesity to be a major contributor to CVD via direct and indirect mechanisms. Although responses in individuals vary widely, lifestyle modifications e.
healthful nutrition, routine aerobic and resistance physical activity generally provide modest weight loss and even independent of weight loss long-term CV benefits. The potential benefits of pharmacological treatment options e. GLP-1 RAs may be discussed alongside lifestyle modifications with appropriate individuals, in line with current and emerging evidence in this rapidly evolving area.
Bariatric surgery has been shown to promote weight loss, reduce CV risk factors, and lower overall CVD risk.
Assessment of body fat, WHR or WC is recommended for people undergoing cardiac rehabilitation to identify those who have excess total or visceral adiposity and are likely to benefit from further investigation regarding CV risk e. assessment of lipids. There are cases where total and central adiposity are undetected in individuals with a relatively low BMI.
Future treatment options for obesity have the potential to deliver substantial and sustained weight loss and provide an opportunity to clarify the impact of intentional weight reduction on CV risk and mortality. Clinicians should, in the meantime, diagnose obesity in people with CVD or at risk for CVD to better allow a patient-centred approach and to maximize the chances of attaining a healthful body weight and reduced CVD risk.
All named authors meet the International Committee of Medical Journal Editors ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.
The authors would like to thank Lana Raspail World Heart Federation and Claudia Batz World Obesity Federation for their assistance and input during the development of the paper. Medical writing services were provided on behalf of the authors by Rebecca Down at Copperfox Communications Limited.
The development of this paper was supported by an unrestricted educational grant from Novo Nordisk. Novo Nordisk was not involved in the preparation of this manuscript and had no control over the content.
No datasets were generated or analysed during the development of this review paper. All data discussed in this paper were published previously. Please refer to the original publications cited in the reference list for further details of individual datasets. World Health Organization.
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ROCHESTER, Minn. A new JACC review paper from Mayo Clinic Obesity and heart disease anc Weight management solutions affects disesae common Intermittent fasting schedule used to diagnose heart disease disrase impacts diaease. Cardiovascular disease is the leading hert of death Obestiy the U. and globally, yet it is largely preventable. Procedural interventions such as stent placement via the leg, or heart surgery, can be more difficult to perform in patients with significant obesity and may involve more complications, like increased risk of infection at the wound site. Common drug therapies to treat cardiovascular disease may need to be adjusted up or down in patients with obesity. Lopez-Jimenez stresses the importance of trying alternative approaches to prevent these patients from gaining weight or help them to lose weight.
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