Residual cardiovascular risk among people with diabetes

Obesity is a chronic multisystem disease associated with increased morbidity and mortality. The increasing prevalence of obesity makes it a major healthcare challenge across both developed and developing countries. Traditional measures such as body mass index do not always identify individuals at increased risk of comorbidities, yet continue to be used in deciding who qualifies for weight loss treatment. A better understanding of how obesity is associated with comorbidities, in particular non‐metabolic conditions, is needed to identify individuals at risk in order to prioritize treatment. For metabolic disorders such as type 2 diabetes (T2D), weight loss can prevent T2D in individuals with prediabetes. It can improve and reverse T2D if weight loss is achieved early in the course of the disease. However, access to effective weight loss treatments is a significant barrier to improved health for people with obesity. In the present paper, we review the rising prevalence of obesity and why it should be classed as a multisystem disease. We will discuss potential mechanisms underlying its association with various comorbidities and how these respond to treatment, with a particular focus on cardiometabolic disease, malignancy and mental health.

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“…TRL undergo lipolysis to yield remnant particles. Both TRL remnants and small‐dense LDL probably have atherogenic properties 83 …”

Section: Obesity As a Multisystem Diseasementioning

confidence: 99%

Obesity as a multisystem disease: Trends in obesity rates and obesity‐related complications

Sarma

Sockalingam

Dash

2021

Diabetes Obesity Metabolism

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221

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“…With marked LDL-C reduction, vascular lesions in most patients either do not expand or regress and become more stable (Nicholls et al, 2011). Despite marked cholesterol reduction, patients with diabetes (mostly T2DM) still have more CVD events (Dash and Leiter, 2019). Limited data in humans also support the concept that diabetes prevents regression (Nicholls et al, 2008).…”

Section: Reviewmentioning

confidence: 99%

Cardiovascular disease in diabetes, beyond glucose

2021

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“…Weight gain in the presence of reduced adipose storage capacity leads to ectopic lipid deposition in the liver, skeletal muscle, and pancreas and increase in visceral adipose tissue (Figure 1) (13,14). The BMI threshold at which this occurs is variable and influenced by age, ethnicity, sex, and genetic factors (13,14). Although obesity rates are higher in women, pre-menopausal women are protected from metabolic disease (21)(22)(23)(24)(25)(26).…”

Section: Obesity and Insulin Resistance In T2dmentioning

confidence: 99%

“…Notably, obesity is associated with chronic low-grade inflammation, which is a plausible mediator of the increased CVD seen in people with obesity (10)(11)(12)(13)(14). Here we will review the association between inflammation, obesity and ACVD.…”

Section: Introductionmentioning

confidence: 99%

Obesity and Cardiovascular Disease: The Emerging Role of Inflammation

Khafagy

Dash

2021

Front. Cardiovasc. Med.

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Obesity is a growing public health challenge across the globe. It is associated with increased morbidity and mortality. Cardiovascular disease (CVD) is the leading cause of mortality for people with obesity. Current strategies to reduce CVD are largely focused on addressing traditional risk factors such as dyslipidemia, type 2 diabetes (T2D) and hypertension. Although this approach is proven to reduce CVD, substantial residual risk remains for people with obesity. This necessitates a better understanding of the etiology of CVD in people with obesity and alternate therapeutic approaches. Reducing inflammation may be one such strategy. A wealth of animal and human data indicates that obesity is associated with adipose tissue and systemic inflammation. Inflammation is a known contributor to CVD in humans and can be successfully targeted to reduce CVD. Here we will review the etiology and pathogenesis of inflammation in obesity associated metabolic disease as well as CVD. We will review to what extent these associations are causal based on human genetic studies and pharmacological studies. The available data suggests that anti-inflammatory treatments can be used to reduce CVD, but off-target effects such as increased infection have precluded its broad therapeutic application to date. The role of anti-inflammatory therapies in improving glycaemia and metabolic parameters is less established. A number of clinical trials are currently ongoing which are evaluating anti-inflammatory agents to lower CVD. These studies will further clarify whether anti-inflammatory agents can safely reduce CVD.

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Residual cardiovascular risk among people with diabetes

Cited by 17 publications

References 108 publications

Obesity as a multisystem disease: Trends in obesity rates and obesity‐related complications

Obesity as a multisystem disease: Trends in obesity rates and obesity‐related complications

Cardiovascular disease in diabetes, beyond glucose

Obesity and Cardiovascular Disease: The Emerging Role of Inflammation

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