Learn why the conversation about obesity cannot wait for your patients with CVD risk factors
How can obesity contribute to the risk of cardiovascular disease?
Obesity can lead to enlarged adipose tissue cells, or adipocytes, which secrete adipokines that promote low-grade systemic inflammation.1 This increased adipose tissue can further lead to endothelial dysfunction, vascular breakdown, and structural and functional myocardial damage, contributing to serious cardiovascular conditions.2-4
Obesity is associated with certain cardiometabolic risk factors, including hypertension, dyslipidemia, and type 2 diabetes.5
Obesity and its related risk factors can lead to the development of cardiovascular diseases, including coronary artery disease, myocardial infarction, and heart failure.3,5,6
A case-cohort study showed:
~6x
increased risk of developing type 2 diabetes compared with patients with normal weight.7
A case-cohort study conducted from the Danish Diet, Cancer and Health cohort included 4,729 individuals who developed T2D and a randomly selected subcohort of 5,402 individuals. Participants were followed for a median of 14.7 years. The study assessed the joint association of genetic predisposition, obesity, and unfavorable lifestyle with the development of T2D. Genetic predisposition was quantified using a genetic risk score (GRS) based on 193 known T2D-associated loci. Body weight was categorized as normal, overweight, and obese. Lifestyle was evaluated using a score based on smoking, alcohol consumption, physical activity, and diet.7
~60%-70%
prevalence of dyslipidemia compared with patients with normal weight.8
Data from the National Health and Nutrition Examination Survey (1999-2002). Dyslipidemia was defined as having ≥1 of the following: total cholesterol ≥240 mg/dL, TGs ≥200 mg/dL, LDL cholesterol ≥160 mg/dL, or HDL cholesterol <40 mg/dL. The relationship between BMI and the prevalence of metabolic diseases, including dyslipidemia, was analyzed.8
Obesity can lead to cardiovascular disease comorbidities
The impact of long-term BMI changes in overweight or obese adults on the risk of heart failure, CVD, and mortality associated with different BMI trajectories was analyzed in a large population-based cohort study that followed 264,230 United Kingdom residents for a median duration of 10 years9:
Increased risk from Overweight (mean BMI=28.7 kg/m2) to Obesity Class 1 (mean BMI=33.7 kg/m2)9
Patients with obesity had a significantly higher risk of cardiovascular disease, heart failure, and CVD-related death than those who were only overweight.
Study design: Population-based cohort study using data from the UK Clinical Practice Research Datalink (CPRD), a national representative database of routinely recorded primary care electronic health records. The study included 264,230 individuals aged ≥18 years with no preexisting records of CVD, and with a recorded or computed BMI of ≥25 kg/m2. Participants were followed for a median duration of 10.9 years. The data were adjusted for age, sex, and comorbidities. Four distinct BMI trajectories were identified, with the Obesity Class 1 group having a mean baseline BMI of 33.7 kg/m2.9
OBESITY INCREASES THE LIFETIME RISK FOR A FIRST CVD EVENT IN MIDDLE-AGED MALE AND FEMALE PATIENTS BY 67% TO 85%10
CVD events included fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, congestive heart failure, and cardiovascular death; based on competing HRs adjusted for age, race/ethnicity, and smoking status.10
Study design: A population-based study calculated lifetime risk estimates of incident CVD using pooled individual-level data from 190,672 person examinations (1964-2015) totaling 3.2 million person-years from numerous longitudinal cohort studies stratified by index age groups, sex, and BMI. Data included 10 prospective cohort studies in which patients were free of clinical CVD at baseline. Middle-aged, 40 to 59 years.10
BRING OBESITY TO THE FOREFRONT
WITH YOUR PATIENTS WITH CVD RISK FACTORS
Weight loss of 5% to 15% or more can improve12,13:
- Blood sugar levels
- Lipids (cholesterol & triglycerides)
- Blood pressure
BMI, body mass index; CVD, cardiovascular disease; HDL, high-density lipoprotein; HR, hazard ratio; ICD, International Classification of Diseases; LDL, low-density lipoprotein; T2D, type 2 diabetes; TG, triglyceride.
DISEASE PROGRESSION
Obesity is caused by a range of factors14,15
INITIATING A PLAN
Patients may be waiting for health care professionals to discuss weight management
References:
1. Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376:254-266.
2. Cercato C, Fonseca FA. Cardiovascular risk and obesity. Diabetol Metab Syndr. 2019;11:74.
3. Cohen JB. Hypertension in obesity and the impact of weight loss. Curr Cardiol Rep. 2017;19(10):98.
4. Csige I, Ujvãrosy D, Szabõ Z, et al. The impact of obesity on the cardiovascular system. J Diab Res. 2018;2018:1-12.
5. Powell-Wiley TM, Poirier P, Burke LE, et al; American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21):e984-e1010.
6. Thomsen M, Nordestgaard G. Myocardial infarction and ischemic heart disease in overweight and obesity with and without metabolic syndrome. JAMA Intern Med. 2014;174:15-22.
7. Schnurr TM, Jakupović H, Carrasquilla GD, et al. Obesity, unfavourable lifestyle and genetic risk of type 2 diabetes: a case-cohort study. Diabetologia. 2020;63:(7)1324-1332.
8. Bays HE, Toth PP, Kris-Etherton PM, et al. Obesity, adiposity, and dyslipidemia: a consensus statement from the National Lipid Association. J Clin Lipidol. 2013;7(4):304-383.
9. Iyen B, Weng S, Vinogradova Y, Akyea RK, Qureshi N, Kai J. Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK. BMC Public Health. 2021;21(1):576.
10. Khan SS, Ning H, Wilkins JT, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3(4):280-287.
11. Raisi-Estabragh Z, Kobo O, Mieres JH, et al. Racial disparities in obesity-related cardiovascular mortality in the United States: temporal trends from 1999 to 2020. J Am Heart Assoc. 2023;12(18):e028409.
12. Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Curr Obes Rep. 2017;6(2):187-194.
13. Garvey WT, Mechanick JI, Brett EM, et al; Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocrine Pract. 2016;22(suppl 3):1-203.
14. Lee A, Cardel M, Donahoo WT. Social and environmental factors influencing obesity. Updated October 12, 2019. In: Feingold KR, Anawalt BB, Blackman MR, et al eds. Endotext. [Internet]. South Dartmouth, MA: MDText.com; 2000. Accessed September 23, 2024. https://www.ncbi.nlm.nih.gov/books/NBK278977/
15. Thaker VV. Genetic and epigenetic causes of obesity. Adolesc Med State Art Rev. 2017;28(2):379-405.
