The obesity epidemic and its cardiovascular consequences.
OBJECTIVE
Obesity has reached global epidemic proportions because of an increasingly obesogenic environment. This review examines the association between obesity, and in particular visceral fat, as a risk factor for cardiovascular disease and mortality.


RESULTS
The World Health Organization defines obesity based on the body mass index. Recently the waist-to-hip ratio has been shown to be a significantly stronger predictor of cardiovascular events than body mass index. The metabolic syndrome and its evolving definition represent a cluster of metabolic risk factors which help predict cardiovascular disease and mortality. Although insulin resistance plays a central role in the pathophysiology of the metabolic syndrome, there is limited support for therapy with insulin sensitizers, thiazolidinediones, in patients with coronary artery disease. The current anti-obesity drugs, orlistat and sibutramine, have only a modest effect on weight loss. The blockade of the endocannabinoid system with rimonabant, however, may be a promising new strategy.


CONCLUSIONS
Obesity is associated with significant increase in cardiovascular risk. Lifestyle modification remains the cornerstone of management although anti-obesity medications may be indicated in high risk individuals with comorbid disease.
Behn
Agnieszka
A
Division of Endocrinology and Metabolism, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Ur
Ehud
E
D001067:Appetite Depressants / Q000627:therapeutic use; D050218:Body Fat Distribution; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D003503:Cyclobutanes / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000378:metabolism; D007783:Lactones / Q000627:therapeutic use; D008019:Life Style; D050356:Lipid Metabolism; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology; D009765:Obesity / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D000077403:Orlistat; D010880:Piperidines / Q000627:therapeutic use; D011720:Pyrazoles / Q000627:therapeutic use; D000077285:Rimonabant; D045162:Thiazolidinediones / Q000627:therapeutic use; D049629:Waist-Hip Ratio
D001067:Appetite Depressants; D003503:Cyclobutanes; D007783:Lactones; D010880:Piperidines; D011720:Pyrazoles; D045162:Thiazolidinediones; D000077403:Orlistat; D000077285:Rimonabant; C058254:sibutramine