title: The obesity epidemic and its cardiovascular consequences.
abstract: 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.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Behn
authors.forename: Ehud
authors.initials: E
authors.lastname: Ur
mesh_terms: 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
chemical_list: D001067:Appetite Depressants; D003503:Cyclobutanes; D007783:Lactones; D010880:Piperidines; D011720:Pyrazoles; D045162:Thiazolidinediones; D000077403:Orlistat; D000077285:Rimonabant; C058254:sibutramine