Abdominal obesity: the cholesterol of the 21st century?
Cardiovascular disease (CVD) is a leading cause of morbidity and death in many countries worldwide. With the help of epidemiological, metabolic and clinical studies conducted over the past decades, the key factors contributing to the development of CVD have been identified. In this regard, several modifiable (hypertension, smoking, elevated cholesterol or low-density lipoprotein-cholesterol concentrations, reduced levels of high-density lipoprotein-cholesterol, type 2 diabetes) and nonmodifiable (age, sex, genetic predisposition) CVD risk factors have been recognized. Although better acute care and chronic pharmacological management have contributed to reduce CVD mortality, CVD morbidity remains very high. It has been proposed that this situation could be the consequence of the evolving landscape of CVD risk factors, which include, among others, poor nutritional habits and a reduction in physical activity contributing to the epidemic of obesity sweeping the world. However, obesity is heterogeneous both in terms of its etiology and its metabolic complications. Body fat distribution, especially visceral adipose tissue accumulation, has been found to be a major correlate of a cluster of diabetogenic and atherogenic abnormalities that has been described as the metabolic syndrome. The importance of abdominal obesity in association with the development of CVD and type 2 diabetes has been recognized in several studies, beyond the contribution of overall obesity. Additional evidence also suggests that the CVD risk related to the hyperglycemic state observed in subjects with the metabolic syndrome or type 2 diabetes is largely explained by the high prevalence of the metabolic complications of abdominal obesity. Although the presence of the metabolic syndrome clearly increases CVD risk, its clinical diagnosis is not sufficient to classify a patient at high risk for a cardiovascular event because attention must also be paid to the presence of traditional risk factors in the calculation of global CVD risk. The additional information provided by the metabolic syndrome to the risk attributed to traditional risk factors in the calculation of global CVD risk has been defined as global cardiometabolic risk. The fight against abdominal obesity as a major cause of CVD morbidity and mortality will require major societal changes and the involvement of dieticians, kinesiologists and behaviour modification specialists in clinical practice to reshape our physical activity and dietary habits. Finally, the early prevention of overweight/obesity/abdominal obesity in children, starting as early as conception, and the identification of key drivers of unhealthy nutritional and sedentary behaviours are the cornerstone of a successful comprehensive plan to fight CVD morbidity.
Després
Jean-Pierre
JP
Québec Heart Institute, Quebec City, Quebec. Jean-Pierre.Despres@crhl.ulaval.ca
Arsenault
Benoit J
BJ
Côté
Mélanie
M
Cartier
Amélie
A
Lemieux
Isabelle
I
D050153:Abdominal Fat; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D002784:Cholesterol / Q000097:blood*; D014943:Global Health; D006801:Humans; D009017:Morbidity; D009765:Obesity / Q000097:blood / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors
D002784:Cholesterol
N Engl J Med. 2007 Jun 7;356(23):2388-98
17554120
Ann Intern Med. 1964 Nov;61:888-99
14233810
Diabetes Care. 1993 Feb;16(2):434-44
8432214
Arteriosclerosis. 1990 Jul-Aug;10(4):497-511
2196040
JAMA. 2003 Nov 5;290(17):2271-6
14600185
Curr Opin Cardiol. 2007 Jul;22(4):280-5
17556878
Diabetes Care. 2008 Jan;31(1):170-2
17934152
Diabetes. 2003 May;52(5):1210-4
12716754
Am J Clin Nutr. 1956 Jan-Feb;4(1):20-34
13282851
Diabetes Care. 2006 Jun;29(6):1417-9
16732038
J Clin Endocrinol Metab. 1982 Feb;54(2):254-60
7033275
J Clin Endocrinol Metab. 2002 Nov;87(11):5044-51
12414870
Arterioscler Thromb Vasc Biol. 2001 Jun;21(6):961-7
11397704
JAMA. 2003 Aug 20;290(7):898-904
12928466
Circulation. 2007 Dec 18;116(25):2933-43
18071080
JAMA. 1986 Nov 28;256(20):2823-8
3773199
N Engl J Med. 2005 Dec 22;353(25):2643-53
16371630
Can J Cardiol. 2007 Oct;23 Suppl B:23B-31B
17932584
J Am Coll Cardiol. 2007 Jan 30;49(4):403-14
17258085
Lancet. 1998 Sep 12;352(9131):837-53
9742976
Can Med Assoc J. 1968 Mar 30;98(13):627-37
5643007
Br Med J (Clin Res Ed). 1984 Nov 10;289(6454):1257-61
6437507
Nature. 2006 Dec 14;444(7121):881-7
17167477
Int J Obes Relat Metab Disord. 2000 Nov;24 Suppl 4:S23-7
11126235
Eur J Clin Invest. 1991 Aug;21(4):398-405
1936107
Am J Physiol Endocrinol Metab. 2002 Mar;282(3):E657-63
11832370
JAMA. 1979 May 11;241(19):2035-8
430798
Can J Cardiol. 2003 Aug;19(9):997-1004
12915926
Am J Med. 2006 Oct;119(10):812-9
17000207
N Engl J Med. 2003 Jan 30;348(5):383-93
12556541
Lancet. 2005 Oct 8;366(9493):1267-78
16214597
JAMA. 2003 Aug 20;290(7):891-7
12928465
Diabetes. 1992 Jul;41(7):826-34
1612197
Diabetes Care. 2007 Jun;30(6):1374-83
17363746
Int J Obes (Lond). 2007 Jan;31(1):177-88
16652128
N Engl J Med. 2001 May 3;344(18):1343-50
11333990
Am J Clin Nutr. 1964 Nov;15:255-61
14220474
Presse Med (1893). 1947 May 24;55(30):339
18918084
Diabetes. 1985 Oct;34(10):1055-8
4043554
Thromb Haemost. 1997 Jul;78(1):656-60
9198234
Circulation. 2007 Oct 23;116(17):1942-51
17965405
Eur Heart J. 2002 May;23(9):706-13
11977996
Lancet. 2005 Nov 5;366(9497):1640-9
16271645
Hypertension. 2006 Nov;48(5):853-60
16982958
JAMA. 1998 Dec 2;280(21):1843-8
9846779
Circulation. 1996 Aug 1;94(3):273-8
8759066
Cell. 1995 Jan 13;80(1):15-8
7813011
N Engl J Med. 2002 Feb 7;346(6):393-403
11832527
CMAJ. 2002 Apr 16;166(8):1039-40
12002980
Br Med J (Clin Res Ed). 1984 May 12;288(6428):1401-4
6426576
Eur Heart J. 1998 Nov;19(11):1632-41
9857915
Am J Med. 1995 Nov;99(5):457-8
7485200
Obes Surg. 2006 Apr;16(4):501-9
16608618
Lancet. 2004 Sep 11-17;364(9438):937-52
15364185
Obes Res. 2003 Oct;11(10):1223-31
14569048
BMJ. 2001 Mar 24;322(7288):716-20
11264213
Diabetes. 1989 Mar;38(3):304-9
2645187
Arch Intern Med. 2005 Oct 10;165(18):2114-20
16217001
Br Med J (Clin Res Ed). 1983 Sep 24;287(6396):867-70
6412862
J Am Coll Cardiol. 2007 Nov 27;50(22):2128-32
18036449
Can J Cardiol. 2006 Jul;22(9):775-80
16835672
Lancet. 2008 Jan 12;371(9607):117-25
18191683