Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation

Abstract

The ongoing obesity epidemic represents a global public health crisis that contributes to poor health outcomes, reduced quality of life and >2.8 million deaths each year. Obesity is relapsing, progressive and heterogeneous. It is considered a chronic disease by the World Obesity Federation (WOF) and a chronic condition by the World Heart Federation (WHF). People living with overweight/obesity are at greater risk for cardiovascular (CV) morbidity and mortality. Increased adiposity (body fat), particularly visceral/abdominal fat, is linked to CV risk and CV disease (CVD) via multiple direct and indirect pathophysiological mechanisms. The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy. Evidence indicates that intentional weight loss (particularly when substantial) lowers CVD risk among people with overweight/obesity. Long-term weight loss and maintenance require ongoing commitment from both the individual and those responsible for their care. This position paper, developed by the WOF and the WHF, aims to improve understanding of the direct and indirect links between overweight/obesity and CVD, the key controversies in this area and evidence relating to cardiometabolic outcomes with available weight management options. Finally, an action plan for clinicians provides recommendations to help in identifying and addressing the risks of obesity-related CVD (recognising resource and support variances between countries).

Obesity and Cardiovascular Risk: Systematic Intervention Is the Key for Prevention

“…Over the past 30 years, there has been a noticeable and steady rise in the prevalence of obesity worldwide [ 1 , 2 , 3 ]. Health care expenses, life expectancy, and mortality are all significantly impacted by this critical global health issue [ 4 ].…”

“…Patients with obesity are associated with an increased risk of cardiovascular (CV) disease, morbidity, and mortality. Specifically, CV risk is high/very high with obesity class I, very high with class II, and extremely high with class III in Caucasian populations [ 3 ]. Furthermore, BMI indicates the overall excess body weight, while the waist circumference (WC) better defines fat distribution and abdominal body fat.…”

“…Furthermore, BMI is limited for defining body composition and the difference between fat mass and fat-free mass. Fat mass disease is associated with the causal promotion of CV disease, and the risk differs according to the type of ectopic deposition [ 3 ]. Regarding this point, cardiac imaging techniques, such as computed tomography and magnetic resonance imaging, provide information about body composition, identification of fat tissue areas, and ectopic deposits.…”

Anti-Obesity and Anti-Inflammatory Effects of Novel Carvacrol Derivatives on 3T3-L1 and WJ-MSCs Cells

“…In this study, based on the clue that Car, one of the main components of oregano and thyme, displayed an anti-adipogenic activity, we screened a small series of Car derivatives to discover more effective drugs endowed with both anti-inflammatory properties and reduced adipogenic activities. The literature data report a strong correlation between obesity and several pathological complications such as cardiovascular or renal dysfunctions, diabetes, and oxidative stress [ 43 , 44 , 45 , 46 ]. Notably, obesity is often also associated with the pro-inflammatory state that characterizes the above-cited pathologies [ 47 ].…”

Insulin resistance mediates obesity-related risk of cardiovascular disease: a prospective cohort study

“…The increase in FFA due to obesity can trigger insulin resistance, which further inhibits insulin signaling and insulin-stimulated glucose uptake in skeletal muscles and increases glucose delivery by the liver [ 42 ]. Additionally, positive energy balance results in adipocyte hypertrophy and ectopic accumulation that leads to metabolic abnormalities, such as insulin resistance and beta-cell dysfunction [ 43 ]. Furthermore, inflammatory factors associated with obesity promote the processes of lipolysis and hepatic triglyceride synthesis, as well as hyperlipidemia induced by increased fatty acid esterification [ 9 ].…”