Targeting abdominal obesity in cardiology: can we be effective?
Obesity has reached epidemic proportions in much of the industrialized world, and is also increasing in prevalence in the developing world. In the later decades of the 20th century until present, there have been numerous epidemiological studies reporting the relationship between excess weight and total, or all-cause, mortality. Obesity is associated with a wide variety of comorbidities such as type 2 diabetes, systemic hypertension, cardiovascular disease, certain cancers and sleep apnea, most of which may lead to disability or death. In general, the risk of developing comorbidities such as diabetes and cardiovascular disease rises as body mass index (BMI) increases. Using BMI, an indicator of relative weight for height (kg/m(2)) and a frequently used surrogate for assessing excess body fat, epidemiological studies have found linear, U- or J-shaped relationships between total mortality and BMI. However, obesity is remarkably heterogeneous. Obese patients considered to be 'at risk' are mostly characterized by features associated with the metabolic syndrome. The aim of the present paper is to review the cardiovascular consequences of obesity and to review some of the literature emphasizing why the cardiologist should measure other indices of adiposity in order to refine clinical assessment of obese individuals.
Poirier
Paul
P
Laval University, Laval Hospital, Sainte Foy, Quebec. Paul.Poirier@crhl.ulaval.ca
D015992:Body Mass Index; D002309:Cardiology / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D014943:Global Health; D006801:Humans; D009017:Morbidity; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000378:metabolism; D012307:Risk Factors
Circulation. 2004 Sep 7;110(10):1245-50
15326067
Int J Obes (Lond). 2005 Jan;29(1):137-41
15520829
Am J Cardiol. 2004 Jan 15;93(2):136-41
14715336
Pediatr Pathol Mol Med. 2002 Mar-Apr;21(2):213-37
11942537
Nutr Rev. 2004 Nov;62(11):448
15622718
Can J Cardiol. 2002 Jul;18(7):725-32
12167959
Circulation. 2006 Jul 4;114(1 Suppl):I512-7
16820629
JAMA. 1998 Dec 2;280(21):1843-8
9846779
Am Heart J. 2005 Jan;149(1):54-60
15660034
Lancet. 2004 Sep 11-17;364(9438):937-52
15364185
Lancet. 2005 Apr 16-22;365(9468):1415-28
15836891
Eur Heart J. 1998 May;19(5):711-9
9717003
Eur Heart J. 2007 Sep;28(17):2047-8
17673449
J Am Coll Cardiol. 2007 Mar 20;49(11):1149-56
17367657
J Cardiopulm Rehabil. 2003 May-Jun;23(3):161-9
12782898
J Am Coll Cardiol. 2007 Aug 28;50(9):843-51
17719470
Arch Intern Med. 2003 Oct 13;163(18):2146-8
14557211
Am J Epidemiol. 2003 Dec 15;158(12):1161-70
14652301
Am J Epidemiol. 2000 Aug 1;152(3):264-71
10933273
J Am Coll Cardiol. 2006 Jun 6;47(11):2229-36
16750688
Circulation. 2007 Sep 11;116(11 Suppl):I213-9
17846306
Can J Surg. 2004 Feb;47(1):34-8
14997923
Ital Heart J. 2003 Dec;4(12):824-8
14976845
Arch Intern Med. 2001 May 14;161(9):1194-203
11343442
JAMA. 2003 Jan 8;289(2):187-93
12517229
Int J Obes Relat Metab Disord. 2001 Feb;25(2):228-32
11410824
Int J Cardiol. 2005 Jan;98(1):123-31
15676176
J Am Coll Cardiol. 2007 Jan 30;49(4):403-14
17258085
Nature. 2006 Dec 14;444(7121):881-7
17167477
Diabetes Care. 2005 Sep;28(9):2289-304
16123508
Diabetes Care. 2001 Apr;24(4):683-9
11315831
Am Heart J. 2004 Jul;148(1):1-4
15215784
J Am Coll Cardiol. 2007 Jul 17;50(3):234-42
17631216
Lancet. 2006 Aug 19;368(9536):666-78
16920472
Ultrasound Med Biol. 2001 Sep;27(9):1199-205
11597360
Nature. 2002 Jun 13;417(6890):750-4
12066187
Nutr Rev. 2004 Jul;62(7 Pt 2):S120-6
15387477
Am J Clin Nutr. 2002 Jun;75(6):1107-13
12036820
J Am Geriatr Soc. 2006 Mar;54(3):413-20
16551307
South Med J. 1991 Aug;84(8):961-5
1882272
N Engl J Med. 2005 Mar 17;352(11):1138-45
15784668
Eur Heart J. 2006 Jun;27(12):1390-1
16707550
J Am Geriatr Soc. 2005 Dec;53(12):2112-8
16398895
Am J Clin Nutr. 2006 Aug;84(2):449-60
16895897
JAMA. 2002 Dec 4;288(21):2709-16
12460094
Obes Res. 2003 Jul;11(7):895-903
12855760
Obes Surg. 1997 Dec;7(6):521-2
9730513
Circulation. 2005 Apr 19;111(15):1883-90
15837940
Circulation. 2007 Oct 23;116(17):1942-51
17965405
Eur Heart J. 2002 May;23(9):706-13
11977996
Int J Obes Relat Metab Disord. 2001 Nov;25(11):1730-5
11753597
Lancet. 2005 Nov 5;366(9497):1640-9
16271645
J Am Coll Cardiol. 2007 Aug 21;50(8):752-9
17707180
Circulation. 2006 May 2;113(17):2113-9
16636166
Circulation. 2006 Feb 14;113(6):898-918
16380542
J Am Coll Cardiol. 1986 Feb;7(2):295-9
3944347
Lab Invest. 1968 May;18(5):560-4
5681198
Int J Obes (Lond). 2005 Jul;29(7):778-84
15917857