title: Abdominal obesity: the cholesterol of the 21st century?
abstract: 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.
authors.affiliation: Québec Heart Institute, Quebec City, Quebec. Jean-Pierre.Despres@crhl.ulaval.ca
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Després
authors.forename: Benoit J
authors.initials: BJ
authors.lastname: Arsenault
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.forename: Amélie
authors.initials: A
authors.lastname: Cartier
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lemieux
mesh_terms: 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
chemical_list: D002784:Cholesterol
references.citation: N Engl J Med. 2007 Jun 7;356(23):2388-98
references.pmid: 17554120
references.citation: Ann Intern Med. 1964 Nov;61:888-99
references.pmid: 14233810
references.citation: Diabetes Care. 1993 Feb;16(2):434-44
references.pmid: 8432214
references.citation: Arteriosclerosis. 1990 Jul-Aug;10(4):497-511
references.pmid: 2196040
references.citation: JAMA. 2003 Nov 5;290(17):2271-6
references.pmid: 14600185
references.citation: Curr Opin Cardiol. 2007 Jul;22(4):280-5
references.pmid: 17556878
references.citation: Diabetes Care. 2008 Jan;31(1):170-2
references.pmid: 17934152
references.citation: Diabetes. 2003 May;52(5):1210-4
references.pmid: 12716754
references.citation: Am J Clin Nutr. 1956 Jan-Feb;4(1):20-34
references.pmid: 13282851
references.citation: Diabetes Care. 2006 Jun;29(6):1417-9
references.pmid: 16732038
references.citation: J Clin Endocrinol Metab. 1982 Feb;54(2):254-60
references.pmid: 7033275
references.citation: J Clin Endocrinol Metab. 2002 Nov;87(11):5044-51
references.pmid: 12414870
references.citation: Arterioscler Thromb Vasc Biol. 2001 Jun;21(6):961-7
references.pmid: 11397704
references.citation: JAMA. 2003 Aug 20;290(7):898-904
references.pmid: 12928466
references.citation: Circulation. 2007 Dec 18;116(25):2933-43
references.pmid: 18071080
references.citation: JAMA. 1986 Nov 28;256(20):2823-8
references.pmid: 3773199
references.citation: N Engl J Med. 2005 Dec 22;353(25):2643-53
references.pmid: 16371630
references.citation: Can J Cardiol. 2007 Oct;23 Suppl B:23B-31B
references.pmid: 17932584
references.citation: J Am Coll Cardiol. 2007 Jan 30;49(4):403-14
references.pmid: 17258085
references.citation: Lancet. 1998 Sep 12;352(9131):837-53
references.pmid: 9742976
references.citation: Can Med Assoc J. 1968 Mar 30;98(13):627-37
references.pmid: 5643007
references.citation: Br Med J (Clin Res Ed). 1984 Nov 10;289(6454):1257-61
references.pmid: 6437507
references.citation: Nature. 2006 Dec 14;444(7121):881-7
references.pmid: 17167477
references.citation: Int J Obes Relat Metab Disord. 2000 Nov;24 Suppl 4:S23-7
references.pmid: 11126235
references.citation: Eur J Clin Invest. 1991 Aug;21(4):398-405
references.pmid: 1936107
references.citation: Am J Physiol Endocrinol Metab. 2002 Mar;282(3):E657-63
references.pmid: 11832370
references.citation: JAMA. 1979 May 11;241(19):2035-8
references.pmid: 430798
references.citation: Can J Cardiol. 2003 Aug;19(9):997-1004
references.pmid: 12915926
references.citation: Am J Med. 2006 Oct;119(10):812-9
references.pmid: 17000207
references.citation: N Engl J Med. 2003 Jan 30;348(5):383-93
references.pmid: 12556541
references.citation: Lancet. 2005 Oct 8;366(9493):1267-78
references.pmid: 16214597
references.citation: JAMA. 2003 Aug 20;290(7):891-7
references.pmid: 12928465
references.citation: Diabetes. 1992 Jul;41(7):826-34
references.pmid: 1612197
references.citation: Diabetes Care. 2007 Jun;30(6):1374-83
references.pmid: 17363746
references.citation: Int J Obes (Lond). 2007 Jan;31(1):177-88
references.pmid: 16652128
references.citation: N Engl J Med. 2001 May 3;344(18):1343-50
references.pmid: 11333990
references.citation: Am J Clin Nutr. 1964 Nov;15:255-61
references.pmid: 14220474
references.citation: Presse Med (1893). 1947 May 24;55(30):339
references.pmid: 18918084
references.citation: Diabetes. 1985 Oct;34(10):1055-8
references.pmid: 4043554
references.citation: Thromb Haemost. 1997 Jul;78(1):656-60
references.pmid: 9198234
references.citation: Circulation. 2007 Oct 23;116(17):1942-51
references.pmid: 17965405
references.citation: Eur Heart J. 2002 May;23(9):706-13
references.pmid: 11977996
references.citation: Lancet. 2005 Nov 5;366(9497):1640-9
references.pmid: 16271645
references.citation: Hypertension. 2006 Nov;48(5):853-60
references.pmid: 16982958
references.citation: JAMA. 1998 Dec 2;280(21):1843-8
references.pmid: 9846779
references.citation: Circulation. 1996 Aug 1;94(3):273-8
references.pmid: 8759066
references.citation: Cell. 1995 Jan 13;80(1):15-8
references.pmid: 7813011
references.citation: N Engl J Med. 2002 Feb 7;346(6):393-403
references.pmid: 11832527
references.citation: CMAJ. 2002 Apr 16;166(8):1039-40
references.pmid: 12002980
references.citation: Br Med J (Clin Res Ed). 1984 May 12;288(6428):1401-4
references.pmid: 6426576
references.citation: Eur Heart J. 1998 Nov;19(11):1632-41
references.pmid: 9857915
references.citation: Am J Med. 1995 Nov;99(5):457-8
references.pmid: 7485200
references.citation: Obes Surg. 2006 Apr;16(4):501-9
references.pmid: 16608618
references.citation: Lancet. 2004 Sep 11-17;364(9438):937-52
references.pmid: 15364185
references.citation: Obes Res. 2003 Oct;11(10):1223-31
references.pmid: 14569048
references.citation: BMJ. 2001 Mar 24;322(7288):716-20
references.pmid: 11264213
references.citation: Diabetes. 1989 Mar;38(3):304-9
references.pmid: 2645187
references.citation: Arch Intern Med. 2005 Oct 10;165(18):2114-20
references.pmid: 16217001
references.citation: Br Med J (Clin Res Ed). 1983 Sep 24;287(6396):867-70
references.pmid: 6412862
references.citation: J Am Coll Cardiol. 2007 Nov 27;50(22):2128-32
references.pmid: 18036449
references.citation: Can J Cardiol. 2006 Jul;22(9):775-80
references.pmid: 16835672
references.citation: Lancet. 2008 Jan 12;371(9607):117-25
references.pmid: 18191683