Weight problems is a serious contributor to the worldwide CVD burden and requires correct administration

April 22, 2021

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Powell-Wiley does not report any relevant financial information. In the declaration you will find all relevant financial information from all other authors.

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The obesity epidemic was instrumental in making heart disease the leading cause of death worldwide.

In a scientific opinion published in Circulation, a committee compiled the latest clinical data to inform the practice about markers of CV outcomes in obese patients, lifestyle interventions, and more.

In a scientific opinion published in Circulation, a committee compiled the latest clinical data to inform the practice about markers of CV outcomes in obese patients, lifestyle interventions, and more. Data were obtained from Powell-Wiley ™ et al. Traffic. 2021; doi: 10.1161 / CIR.0000000000000973.

“This scientific opinion provides the latest research and information on the relationship between obesity and obesity treatment for coronary artery disease, heart failure and arrhythmias.” Tiffany M. Powell-Wiley, MD, MPH, FAHA, a Stadtman tenure-track investigator and chief of the Laboratory for Social Determinants of Obesity and Cardiovascular Risk in the Intramural Research Division at the NHLBI and chair of the writing committee, said in a press release. “The timing of this information is important as the obesity epidemic is a major contributor to the global burden of cardiovascular disease and numerous chronic conditions that also affect heart disease.”

According to the testimony, there is a relationship between general obesity and abdominal obesity; However, individuals with classified obesity, classified by BMI, may not have abdominal obesity. Therefore, the committee found that a large waist circumference may be a better predictor of CVD risk in individuals of normal weight, as it is also an indicator of abdominal body fat. Belly fat is associated with cardiometabolic disease and CVD and predicts mortality.

The statement was based on data suggesting that metabolically healthy obesity may be a transitory phenotype for many. In addition, compared to those with metabolically healthy obesity, patients with excess visceral adipose tissue represent a subset of people at the highest risk of CVD, regardless of BMI.

“Epicardial adipose tissue represents visceral fat between the outer wall of the myocardium and the visceral layer of the pericardium,” the committee wrote. “This adipose tissue comes from embryonic brown adipose tissue and releases cytokines and chemokines into the vascular system. It has been linked to total cardiovascular score and arterial stiffness in patients with CVD and type 2 diabetes. “

Studies cited in the statement showed that epicardial adipose tissue thickness is related to waist circumference, blood pressure, markers of insulin resistance and dyslipidemia and can therefore be an indicator of CV risk.

Weight Loss and CAD in Obesity

According to the statement, studies have shown that in both men and women of different ages, three to five workouts per week for 12 to 52 weeks reduce visceral adipose tissue compared to no training. In addition, a reduction in visceral adipose tissue was achieved without weight loss. A meta-analysis of training interventions revealed a 6.1% loss of visceral adipose tissue with no weight loss.

A reduction in visceral adipose tissue with high-intensity exercise versus moderate-intensity exercise is reported not always better, and 3 months of walking resulted in a greater reduction compared to controls. This finding suggests that current physical activity recommendations (150 minutes per week) might be enough to reduce adipose tissue without further reductions from additional activity, the committee wrote.

Interventions that lead to weight loss improved CV risk factors, according to the publication. However, weight loss may not always lead to better results in CAD.

A meta-analysis showed that BMI in the overweight and obese area was associated with an increased risk of CAD and at each BMI level, while a higher waist circumference and a higher waist-to-hip ratio were associated with a higher risk of CAD and CV Mortality. These results were consistent for patients of normal weight as assessed by the BMI.

“Lifestyle change with associated weight loss improves both the diagnostic components of metabolic syndrome and associated pathophysiological abnormalities such as systemic inflammation and endothelial dysfunction,” the committee wrote. “Interventional medical weight loss studies have not shown significant reductions in CAD rates.”

However, the Swedish Obesity Study showed that patients who underwent bariatric surgery were at lower risk of CAD compared to non-surgical methods of weight loss and a lower rate of fatal and non-fatal CV events.

The committee found that the reason for the difference in outcomes between surgical and nonsurgical methods of weight loss was related to the degree of weight loss and the risk factor reduction observed in patients who had undergone bariatric surgery.

Recommendations for future research

The committee made the following recommendations for future research on obesity and life course health:

  • Conduct randomized controlled trials that evaluate the role of weight loss and reducing visceral obesity in improving CVD outcomes.
  • Develop dietary interventions using randomized controlled trials to determine healthy eating habits or personalized diets for obese patients to reduce the risk of CV.
  • Develop upstream interventions for primary prevention and better management of obesity as a chronic disease in young patients.
  • Identify best practices for using GLP-1 receptor agonists and SGLT2 inhibitors to reduce HF hospitalization and CV death in HF with reduced ejection fraction and HF with conserved EF with and without diabetes.
  • Developing weight maintenance strategies and improving functional outcomes as opposed to weight loss interventions in older populations at risk of HR.

“As overweight and obesity among adolescents rise around the world, it is important to study how upstream primary prevention measures and better treatment strategies can best be developed, especially for young patients with severe obesity,” Powell-Wiley said in the press release.

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