Obesity cardiovascular disease risk

If the findings relating to obesity and improved glycaemic control can be confirmed in human studies such drugs would be highly attractive. As discussed above, bile-acid sequestrants have been used for many years to treat dyslipi-demia in relation to reducing cardiovascular disease risk and the safety profile of these compounds is well established. However, due to the large doses of compound that require to be consumed, compliance is an issue for BAS therapies. In the future, this may be resolved with the development of more specific and efficient resins that require lower doses. 

Broom, L, Wilding, J., Stott, P. and Myers, N. (2002) Randomised trial of the effect of orlistat on body weight and cardiovascular disease risk profile in obese patients UK Multimorbidity Study. Int. J. 

McLaughlin T, Alhson G, Abbasi F, et al. Prevalence of insulin resistance and associated cardiovascular disease risk factors among normal weight, overweight, and obese individuals. Metabolism 2004 53 495 99. 

Fung TT, Rimm EB, Spiegelman D, et al. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. Am J Clin Nutr. 2001 73 61-67. 

Globally, undernutrition is widespread, leading to impaired growth, defective immune systems, and reduced work capacity. By contrast, in developed countries, there is often excessive food consumption (especially of fat), leading to obesity and to the development of cardiovascular disease and some forms of cancer. Deficiencies of vitamin A, iron, and iodine pose major health concerns in many countries, and deficiencies of other vitamins and minerals are a major cause of iU health. In developed countries, nutrient deficiency is rare, though there are vulnerable sections of the population at risk. Intakes of minerals and vitamins that are adequate to prevent deficiency may be inadequate to promote optimum health and longevity. 

Lifestyle changes should address other risk factors for cardiovascular disease including obesity, physical inactivity, insulin resistance, dyslipidemia, smoking cessation, and others. 

Poor sleep architecture and fragmented sleep secondary to OSA can cause excessive daytime sleepiness (EDS) and neu-rocognitive deficits. These sequelae can affect quality of life and work performance and may be linked to occupational and motor vehicle accidents. OSA is also associated with systemic disease such as hypertension, heart failure, and stroke.21-23 OSA is likely an independent risk factor for the development of hypertension.24 Further, when hypertension is present, it is often resistant to antihypertensive therapy. Fatal and non-fatal cardiovascular events are two- to threefold higher in male patients with severe OSA.25 OSA is associated with or aggravates biomarkers for cardiovascular disease, including C-reactive protein and leptin.26,27 Patients with sleep apnea often are obese and maybe predisposed to weight gain. Hence, obesity may further contribute to cardiovascular disease in this patient population. 

Because of comorbidity with diabetes, dyslipidemia, hypertension, and stroke, the presence of increased serum uric acid levels or gout should prompt evaluation for cardiovascular disease and the need for appropriate risk reduction measures. Clinicians should also look for possible correctable causes of hyperuricemia (e.g., medications, obesity, and alcohol abuse). 

Obesity is associated with serious health risks and increased mortality. Central obesity reflects high levels of intraabdominal or visceral fat that is associated with the development of hypertension, dyslipidemia, type 2 diabetes, and cardiovascular disease. 

As noted above, obesity is a health problem. It is associated with both elevated mortality and morbidity. More specifically, obesity is a risk factor for cardiovascular disease, including heart attack and stroke, and for high blood pressure (hypertension), diabetes, and hyperlipidemia (elevated levels of lipids in the blood, a risk factor for atherosclerosis and its sequelae), and for cancer. 

Obesity is a risk factor for diabetes, cardiovascular disease, and high blood pressure. 

Coronary heart disease is one of the leading causes of death in the industrialized world (Packer, 1992 Remme and Swedberg, 2001). Hypertension is a risk factor for cardiovascular disease and is associated with an increased incidence of stroke and coronary heart disease. Other risk factors for cardiovascular disease include also high cholesterol, diabetes, and obesity. Although there have been many advances in treatment over the past several decades, less than a quarter of all hypertensive patients have their blood pressure adequately controlled with available therapies. 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

Abdominal obesity is associated with a threatening combination of metabolic abnormalities that includes glucose intolerance, insulin resistance, hyperinsulinemia, dyslipidemia (low HDL and elevated VLDL), and hypertension. This clustering of metabolic abnormalities has been referred to as syndrome X, the insulin resistance syndrome, or the metabolic syndrome. Individuals with this syndrome liave a significantly increased risk for developing diabetes mellitus and cardiovascular disorders. For example, men with the syndrome are three to four times more likely to die of cardiovascular disease. 

The consequences of hypertriglyceridemia are not well understood, but there may be an increased risk of cardiovascular disease and pancreatitis (SEDA-13, 123). Patients with an increased tendency to develop hypertriglyceridemia include those with diabetes mellitus, obesity, increased alcohol intake, and a positive family history. With a short course (16 weeks) of isotretinoin it is sufficient to ensure there is no hyperlipidemia before the start of therapy, and to determine the triglyceride response to therapy on one occasion after 4 weeks (1207). 

Hypertension and obesity are common symptoms of both diabetes and sleep-disordered breathing the presence of these symptoms also represents an increased risk for cardiovascular disease. While a relationship between sleep-disordered breathing and cardiovascular disease has been well established, a link between diabetes and cardiovascular disease is less clear. It has been proposed that the cardiovascular autonomic neuropathy (CAN) common in diabetes may contribute to an increased risk for cardiovascular disease (155). 

Rosmond and Bjorntorp also addressed the potential effect of HPA axis activity on established anthropometric, metabolic, and hemodynamic risk factors for cardiovascular disease, type 2 diabetes mellitus, and stroke [112], Strong and consistent correlations were found not only within but also between different clusters of risk factors, including lipid profiles [110]. The close association to HPA axis abnormality may explain the previously reported powerful risk indication of abdominal obesity for the diseases mentioned under environmental stress challenges [112]. 

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