Cardiovascular outcome trials in obesity: A review

Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The “American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update” is a summary document (updated yearly) regarding CVD risk factors. This “ASPC Top Ten CVD Risk Factors 2021 Update” summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the “ASPC Top Ten CVD Risk Factors 2021 Update” to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.

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“…However, CVD outcomes trials are ongoing to determine if existing or future anti-obesity drugs reduce CVD events. [ 5 , 198] …”

Section: Overweight and Obesitymentioning

confidence: 99%

Ten things to know about ten cardiovascular disease risk factors

Bays

Taub

Epstein

et al. 2021

American Journal of Preventive Cardiology

151

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“…The association between different types of pathogenic strokes and the thickness of epicardial fat may be related to the presence of atrial heart disease, which is currently considered one of the possible hidden causes of this type of stroke. In this view, multiple factors (such as inflammation, thickness of epicardial fat, changes in the autonomic nervous system) may be linked to atrial changes that favor the cardioembolic mechanisms in these strokes (41)(42)(43)(44)(45).…”

Section: Discussionmentioning

confidence: 99%

Association Between Epicardial Adipose Tissue and Stroke

Rosa

Grande

Lima

et al. 2021

Front. Cardiovasc. Med.

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Epicardial adipose tissue (EAT) is correlated with endothelial dysfunction, metabolic syndrome, increased mortality and recent studies showed a possible association with the increased risk of stroke. We performed a systematic review of studies evaluating the association between EAT and stroke. Eighty studies met the inclusion criteria and were consequently analyzed. The review had Five main findings. First, the increased epicardial fat thickness (EFT) may be associated with the stroke episode. Second, regardless of the imaging method (echocardiography, MRI, and CT) this association remains. Third, the association of metabolic syndrome and atrial fibrillation seems to increase the risk of stroke. Fourth, this systematic review was considered as low risk of bias. Despite being unable to establish a clear association between EAT and stroke, we have organized and assessed all the research papers on this topic, analyzing their limitations, suggesting improvements in future pieces of research and pointing out gaps in the literature. Furthermore, the mechanistic links between increased EAT and stroke incidence remains unclear, thus, further research is warranted.

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“…These side effects can be mitigated in part with careful titration over weeks or months up to the therapeutic doses. Some GLP-1 analogs have been shown to improve cardiovascular outcomes in patients with T2DM [ 126 ].…”

Section: Harnessing the Gut-brain Axis To Treat Metabolic Diseasesmentioning

confidence: 99%

The gut–brain axis: Identifying new therapeutic approaches for type 2 diabetes, obesity, and related disorders

Richards

Thornberry

Pinto

2021

Molecular Metabolism

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Background The gut-brain axis, which mediates bidirectional communication between the gastrointestinal system and central nervous system (CNS), plays a fundamental role in multiple areas of physiology including regulating appetite, metabolism, and gastrointestinal function. The biology of the gut-brain axis is central to the efficacy of glucagon-like peptide-1 (GLP-1)-based therapies, which are now leading treatments for type 2 diabetes (T2DM) and obesity. This success and research to suggest a much broader role of gut-brain circuits in physiology and disease has led to increasing interest in targeting such circuits to discover new therapeutics. However, our current knowledge of this biology is limited, largely because the scientific tools have not been available to enable a detailed mechanistic understanding of gut-brain communication. Scope of review In this review, we provide an overview of the current understanding of how sensory information from the gastrointestinal system is communicated to the central nervous system, with an emphasis on circuits involved in regulating feeding and metabolism. We then describe how recent technologies are enabling a better understanding of this system at a molecular level and how this information is leading to novel insights into gut-brain communication. We also discuss current therapeutic approaches that leverage the gut-brain axis to treat diabetes, obesity, and related disorders and describe potential novel approaches that have been enabled by recent advances in the field. Major conclusions The gut-brain axis is intimately involved in regulating glucose homeostasis and appetite, and this system plays a key role in mediating the efficacy of therapeutics that have had a major impact on treating T2DM and obesity. Research into the gut-brain axis has historically largely focused on studying individual components in this system, but new technologies are now enabling a better understanding of how signals from these components are orchestrated to regulate metabolism. While this work reveals a complexity of signaling even greater than previously appreciated, new insights are already being leveraged to explore fundamentally new approaches to treating metabolic diseases.

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Cardiovascular outcome trials in obesity: A review

Cited by 53 publications

References 56 publications

Ten things to know about ten cardiovascular disease risk factors

Ten things to know about ten cardiovascular disease risk factors

Association Between Epicardial Adipose Tissue and Stroke

The gut–brain axis: Identifying new therapeutic approaches for type 2 diabetes, obesity, and related disorders

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