Major epidemiologic studies over the last century demonstrated that obesity leads to several severe diseases such as diabetes mellitus, hypertension, coronary heart disease, chronic heart failure, cerebrovascular accidents. In developed countries cardiovascular diseases became the main cause of death. In the last 5–6 years some studies showed that people with overweight and obesity of the first degree have a higher life expectancy than people with normal weight. In 2009, the published data showed that the presence of obesity in patients with chronic heart failure does not impair cardiovascular prognosis. Overweight correlates with a decrease in overall mortality by 25%. And in a first degree of obesity the risk of death is reduced by 12%. This phenomenon is called "obesity paradox" and the causes of which are discussed in this review.

Introduction. In patients with obesity coronary atherosclerosis and chronic heart failure (CHF) progress rapidly and have a worse long-term prognosis than those with normal weight.Objective: To investigate the prognostic significance of GH and IGF-1 in the evaluation of cardiovascular risk in patients with obesity.Materials and Methods. The study included 75 men (mean age 55.31±6.32 years), which are overweight or have mild obesity (body mass index (BMI) 28.69±3.6 kg/m2). Group 1 included 45 patients (age 56.4±6.29 years, BMI 28.69±3.69 kg/m2, blood pressure 124±10.18/80±4.59 mm Hg) who underwent coronary angiography. Group 2 included 30 patients (mean age 53.6 ± 6.1 years, BMI 28.68±3.52 kg/m2, blood pressure 128±9/83±6.81 mm Hg), CAD who are excluded by treadmill test. The coronary artery calcium score was assessed in group 2. All participants were evaluated impaired glucose tolerance (IGT), triglycerides (TG), IGF-1 and GH, LPHD, LPLD, geometry of the heart chambers was assessed by echocardiography.Results. Patients in both groups did not differ in age, BMI, blood pressure. IGF-1 levels were not significantly different among the study groups. High circulating IGF-1 levels were frequently observed in group 1 (р=0.018). A statistically significant association of high IGF-1 observed with obesity (p=0.033), smoking (p=0.049), hypertension (p=0.002), end-diastolic dimension (p=0.045). GH was lower in group 1 compared with group 2 (p=0.046). Serum levels of GH are positively associated with EF (p=0.023) and E/A (p=0.043) and negatively associated with left atrial wall thickness (p=0.025) and coronary artery calcium score (p=0.005).Conclusion: 1. IGF-1 may be a useful indicator to assess the prognosis of CAD and CHF in patients with obesity. 2. Relative GH deficiency was more often associated with severe CAD in patients with obesity.

Background: Research makes it clear that the IGF-1 level correlates with cardiovascular disease, chronic heart failure, and mortality. Yet, little is known about the effect of statins on IGF-1. Aims: to evaluate the effect of statin treatment on IGF-1 and its association with a cardiovascular risk. Material and methods: The study included 115 patients (mean age, 55.8±6.1 years) who either were overweight or had mild obesity (body mass index 28.6±3.8 kg/m2) without diabetes. Group 1 consisted of 70 patients with verified coronary artery disease receiving statin therapy; group 2 included 45 healthy subjects. Coronary angiography and treadmill test were used to diagnose coronary artery disease. Impaired glucose tolerance and total cholesterol, triglycerides, LPHD, LPLD, fibrinogen, and IGF-1 levels were evaluated in all the subjects. Heart chamber geometry was assessed by echocardiography. Results: The IGF-1 level was significantly higher in group 1 compared to the control group (196 and 167 ng/ml, respectively; р=0.014). Serum levels of IGF-1 were associated with duration of statin therapy (R=0.311; p=0.000), stage of hypertension (R=0.187; p=0.04), fibrinogen (R=0.274; p=0.033), TG (R=0.316; p=0.006), total cholesterol (R=–0.213; p=0.016), LPLD (R=–0.184; p=0.038), smoking (R=0.3; p=0.009), ejection fraction (R=0.298; p=0.041), end-diastolic volume (R=0.422; p=0.036), end-systolic volume (R=0.407; p=0.042), end-diastolic dimension (R=0.27; p=0.014), interventricular septal thickness (R=0.247; p=0.02), and left ventricular posterior wall thickness (R=0.258; p=0.019). Rosuvastatin dose positively correlated with the IGF-1 level (R=0.521; p=0.028). Conclusions: Statin administration is associated with higher IGF-1 levels in patients without diabetes. High IGF-1 level correlates with the risk factors of coronary artery disease: hypertension, lipid profile, and fibrinogen level and has an adverse effect on chronic heart failure by altering the cardiac remodeling.

Cardiovascular abnormalities associated with morbid obesity include cardiac hypertrophy, cardiac dilatation, diastolic dysfunction. Also obesity predispose to numerous cardiac complications such as coronary heart disease, heart failure, and sudden death. The cardiovascular clinical evaluation of obese patients may be limited by morphological changes, which are specific for increased amount of body fat mass. The incidence of sudden and unexplained death in morbid obesity may be a manifestation of occult cardiovascular disease in this population.

Objectives: To investigate the role of IGF-1 in the development of cardiac remodeling in patients with overweight and mild obesity.Materials and Methods: The study included 75 men (mean age 55.3 ± 6.3 years), which are overweight or have mild obesity (body mass index (BMI) 28.6 ± 3.6) without diabetes. Group 1 included 46 patients with normal weight and overweight (BMI 26.5 ± 3.6). Group 2 included 27 patients with obesity (mean BMI 32.4 ± 3.5). Coronary artery disease was confirmed by treadmill test and coronarography. All participants were evaluated by impaired glucose tolerance test (IGT), cholesterol, triglycerides (TG), IGF-1 and LPHD, and LPLD levels, geometry of the heart chambers by echocardiography.Results: Patients in both groups did not differ by age, blood pressure, percent of CAD and impaired glucose tolerance. IGF-1 levels were not significantly different among the study groups (210.1 and 216.6 ng/ml, p0.05). High circulating IGF-1 levels were frequently observed in Group 2 (in 50% and 25% patients, respectively; р=0.039). The concentric remodeling for patients with normal IGF-1 seen in 38% of patients compared to 52% in patients with high level of IGF-1. The eccentric hypertrophy for patients with normal IGF-1 was not observed compared to 16% in patients with high level of IGF-1. The concentric hypertrophy for patients with normal IGF-1 was 30.7% compared to 4% in patients with high level of IGF-1.Conclusions: IGF-1 has a significant effect on cardiac remodeling in patients with coronary artery disease and obesity. IGF-1 may be an important marker of prognosis of chronic heart failure in patients with obesity and an indicator of hypertension and associated cardiac remodeling.