title: Abdominal obesity and the metabolic syndrome: a surgeon's perspective.
abstract: Over the past decade, a major shift in the clinical risk factors in the population undergoing a cardiac surgery has been observed. In the general population, an increasing prevalence of obesity has largely contributed to the development of cardiovascular disorders. Obesity is a heterogeneous condition in which body fat distribution largely determines metabolic perturbations. Consequently, individuals characterized by increased abdominal fat deposition and the so-called metabolic syndrome (MetS) have a higher risk of developing coronary artery disease. Recent studies have also emphasized that visceral obesity is a strong risk factor for the development of heart valve diseases. In fact, individuals characterized by visceral obesity and its metabolic consequences, such as the small dense low-density lipoprotein phenotype, have a faster progression rate of aortic stenosis, which is related to increased valvular inflammation. Furthermore, the degenerative process of implanted bioprostheses is increased in subjects with the MetS and/or diabetes, suggesting that a process akin to atherosclerosis could be involved in the failure of bioprostheses. In addition to being an important risk factor for the development of cardiovascular disorders, the MetS is increasing the operative mortality risk following coronary artery bypass graft surgery. Thus, recent evidence supports visceral obesity as a global risk factor that is affecting the development of many heart disorders, and that is also impacting negatively on the results of patients undergoing surgical treatment for cardiovascular diseases. In the present paper, recent concepts surrounding the MetS and its implications in various cardiovascular disorders are reviewed along with the clinical implications.
authors.affiliation: Laval Hospital, Department of Surgery, Laval University, Sainte-Foy, Quebec. patrick.mathieu@chg.ulaval.ca
authors.forename: Patrick
authors.initials: P
authors.lastname: Mathieu
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology; D009017:Morbidity; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors
references.citation: J Am Coll Cardiol. 2006 Jun 6;47(11):2229-36
references.pmid: 16750688
references.citation: J Investig Med. 2007 Sep;55(6):284-91
references.pmid: 17963677
references.citation: J Am Diet Assoc. 2007 Nov;107(11):1966-72
references.pmid: 17964317
references.citation: Am J Physiol Endocrinol Metab. 2005 Jan;288(1):E216-21
references.pmid: 15367397
references.citation: Circulation. 2007 Sep 11;116(11 Suppl):I213-9
references.pmid: 17846306
references.citation: J Am Coll Cardiol. 1997 Mar 1;29(3):630-4
references.pmid: 9060903
references.citation: Am J Cardiol. 2003 Dec 15;92(12):1479-82
references.pmid: 14675593
references.citation: Arch Intern Med. 2005 Apr 25;165(8):858-62
references.pmid: 15851635
references.citation: Diabetes Metab. 1999 Sep;25(3):199-211
references.pmid: 10499189
references.citation: Ann Intern Med. 2006 Oct 3;145(7):554-5; author reply 555
references.pmid: 17015879
references.citation: J Atheroscler Thromb. 2002;9(6):266-75
references.pmid: 12560585
references.citation: Heart. 2006 Dec;92(12):1844-9
references.pmid: 16709694
references.citation: Biochimie. 2005 Jan;87(1):57-64
references.pmid: 15733738
references.citation: J Am Coll Cardiol. 2007 Aug 28;50(9):843-51
references.pmid: 17719470
references.citation: Annu Rev Med. 2002;53:319-36
references.pmid: 11818477
references.citation: Arterioscler Thromb Vasc Biol. 2008 Jan;28(1):187-93
references.pmid: 17975118
references.citation: N Engl J Med. 2005 Jun 9;352(23):2389-97
references.pmid: 15944423
references.citation: Ann Intern Med. 2006 Apr 4;144(7):517-24
references.pmid: 16585666
references.citation: J Clin Endocrinol Metab. 2000 Jul;85(7):2378-84
references.pmid: 10902782
references.citation: J Am Coll Cardiol. 2007 Feb 6;49(5):554-61
references.pmid: 17276178
references.citation: Comp Biochem Physiol B. 1989;94(2):225-32
references.pmid: 2591189
references.citation: Heart. 2003 Jul;89(7):767-72
references.pmid: 12807853
references.citation: Nature. 2006 Dec 14;444(7121):881-7
references.pmid: 17167477
references.citation: J Heart Valve Dis. 2005 May;14(3):353-7
references.pmid: 15974530
references.citation: J Biomed Mater Res. 1994 Jan;28(1):35-47
references.pmid: 8126027
references.citation: Circulation. 2002 Oct 22;106(17):2224-30
references.pmid: 12390952
references.citation: Ital Heart J. 2004 Feb;5(2):85-8
references.pmid: 15086137
references.citation: Rev Port Cardiol. 2007 Jan;26(1):51-62
references.pmid: 17427836
references.citation: J Thorac Cardiovasc Surg. 2003 Oct;126(4):969-75
references.pmid: 14566234
references.citation: Circulation. 2006 Jul 25;114(4):318-27
references.pmid: 16831988
references.citation: Trends Endocrinol Metab. 2003 Nov;14(9):398-403
references.pmid: 14580758
references.citation: Atherosclerosis. 2002 Jun;162(2):363-71
references.pmid: 11996956
references.citation: Circulation. 2004 Sep 7;110(10):1291-5
references.pmid: 15337704
references.citation: Circulation. 1994 Aug;90(2):844-53
references.pmid: 7519131
references.citation: Ann Thorac Surg. 2005 Mar;79(3):1072-80
references.pmid: 15734452
references.citation: Circulation. 2006 Jul 4;114(1 Suppl):I512-7
references.pmid: 16820629
references.citation: Hypertension. 2005 Jun;45(6):1031-4
references.pmid: 15897372
references.citation: Cardiovasc Diabetol. 2006 Jan 13;5:1
references.pmid: 16412224
references.citation: J Atheroscler Thromb. 2005;12(6):295-300
references.pmid: 16394610
references.citation: Atherosclerosis. 1992 Apr;93(3):189-99
references.pmid: 1590824
references.citation: Eur J Cardiothorac Surg. 2004 Mar;25(3):364-70
references.pmid: 15019662
references.citation: Atherosclerosis. 1996 Jun;123(1-2):43-56
references.pmid: 8782836
references.citation: Curr Opin Lipidol. 2007 Oct;18(5):483-91
references.pmid: 17885417
references.citation: Nat Clin Pract Cardiovasc Med. 2007 Apr;4(4):192-3
references.pmid: 17297484
references.citation: J Am Coll Cardiol. 2002 Nov 20;40(10):1723-30
references.pmid: 12446053
references.citation: J Am Coll Cardiol. 1993 Apr;21(5):1220-5
references.pmid: 8459080
references.citation: Int J Biochem Cell Biol. 2008;40(5):821-36
references.pmid: 18201922
references.citation: Can J Cardiol. 2007 Oct;23 Suppl B:32B-39B
references.pmid: 17932585