Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management

Ian J. Neeland, Paul Poirier, Jean Pierre Després

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

The prevalence of obesity has increased globally over the last 2 decades. Although the body mass index has been a convenient and simple index of obesity at the population level, studies have shown that obesity defined by body mass index alone is a remarkably heterogeneous condition with varying cardiovascular and metabolic manifestations across individuals. Adipose tissue is an exquisitely active metabolic organ engaged in cross-talk between various systems; perturbation of adipose tissue results in a pathological response to positive caloric balance in susceptible individuals that directly and indirectly contributes to cardiovascular and metabolic disease. Inadequate subcutaneous adipose tissue expansion in the face of dietary triglycerides leads to visceral and ectopic fat deposition, inflammatory/adipokine dysregulation, and insulin resistance. Conversely, preferential fat storage in the lower body depot may act as a metabolic buffer and protect other tissues from lipotoxicity caused by lipid overflow and ectopic fat. Translational, epidemiological, and clinical studies over the past 30 years have clearly demonstrated a strong link between visceral and ectopic fat and the development of a clinical syndrome characterized by atherogenic dyslipidemia, hyperinsulinemia/glucose intolerance, hypertension, atherosclerosis, and adverse cardiac remodeling/heart failure. This relationship is even more nuanced when clinical entities such as metabolically healthy obesity phenotype and the obesity paradox are considered. Although it is clear that the accumulation of visceral/ectopic fat is a major contributor to cardiovascular and metabolic risk above and beyond the body mass index, implementation of fat distribution assessment into clinical practice remains a challenge. Anthropometric indexes of obesity are easily implemented, but newer imaging-based methods offer improved sensitivity and specificity for measuring specific depots. Lifestyle, pharmacological, and surgical interventions allow a multidisciplinary approach to overweight/obesity that may improve outcomes and align with a public health message to combat the growing epidemic of obesity worldwide and to build healthier lives free of cardiovascular diseases.

Original languageEnglish (US)
Pages (from-to)1391-1406
Number of pages16
JournalCirculation
Volume137
Issue number13
DOIs
StatePublished - Mar 27 2018

Fingerprint

Obesity
Intra-Abdominal Fat
Body Mass Index
Fats
Adipose Tissue
Cardiovascular Diseases
Tissue Expansion
Adipokines
Glucose Intolerance
Subcutaneous Fat
Metabolic Diseases
Hyperinsulinism
Dyslipidemias
Insulin Resistance
Life Style
Epidemiologic Studies
Atherosclerosis
Buffers
Triglycerides
Heart Failure

Keywords

  • adiposity
  • cardiac imaging techniques
  • cardiovascular diseases
  • obesity
  • risk factors
  • waist circumference

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Cardiovascular and Metabolic Heterogeneity of Obesity : Clinical Challenges and Implications for Management. / Neeland, Ian J.; Poirier, Paul; Després, Jean Pierre.

In: Circulation, Vol. 137, No. 13, 27.03.2018, p. 1391-1406.

Research output: Contribution to journalArticle

Neeland, Ian J. ; Poirier, Paul ; Després, Jean Pierre. / Cardiovascular and Metabolic Heterogeneity of Obesity : Clinical Challenges and Implications for Management. In: Circulation. 2018 ; Vol. 137, No. 13. pp. 1391-1406.
@article{fbcd1da986ea437693ec1ab24a6e703c,
title = "Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management",
abstract = "The prevalence of obesity has increased globally over the last 2 decades. Although the body mass index has been a convenient and simple index of obesity at the population level, studies have shown that obesity defined by body mass index alone is a remarkably heterogeneous condition with varying cardiovascular and metabolic manifestations across individuals. Adipose tissue is an exquisitely active metabolic organ engaged in cross-talk between various systems; perturbation of adipose tissue results in a pathological response to positive caloric balance in susceptible individuals that directly and indirectly contributes to cardiovascular and metabolic disease. Inadequate subcutaneous adipose tissue expansion in the face of dietary triglycerides leads to visceral and ectopic fat deposition, inflammatory/adipokine dysregulation, and insulin resistance. Conversely, preferential fat storage in the lower body depot may act as a metabolic buffer and protect other tissues from lipotoxicity caused by lipid overflow and ectopic fat. Translational, epidemiological, and clinical studies over the past 30 years have clearly demonstrated a strong link between visceral and ectopic fat and the development of a clinical syndrome characterized by atherogenic dyslipidemia, hyperinsulinemia/glucose intolerance, hypertension, atherosclerosis, and adverse cardiac remodeling/heart failure. This relationship is even more nuanced when clinical entities such as metabolically healthy obesity phenotype and the obesity paradox are considered. Although it is clear that the accumulation of visceral/ectopic fat is a major contributor to cardiovascular and metabolic risk above and beyond the body mass index, implementation of fat distribution assessment into clinical practice remains a challenge. Anthropometric indexes of obesity are easily implemented, but newer imaging-based methods offer improved sensitivity and specificity for measuring specific depots. Lifestyle, pharmacological, and surgical interventions allow a multidisciplinary approach to overweight/obesity that may improve outcomes and align with a public health message to combat the growing epidemic of obesity worldwide and to build healthier lives free of cardiovascular diseases.",
keywords = "adiposity, cardiac imaging techniques, cardiovascular diseases, obesity, risk factors, waist circumference",
author = "Neeland, {Ian J.} and Paul Poirier and Despr{\'e}s, {Jean Pierre}",
year = "2018",
month = "3",
day = "27",
doi = "10.1161/CIRCULATIONAHA.117.029617",
language = "English (US)",
volume = "137",
pages = "1391--1406",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "13",

}

TY - JOUR

T1 - Cardiovascular and Metabolic Heterogeneity of Obesity

T2 - Clinical Challenges and Implications for Management

AU - Neeland, Ian J.

AU - Poirier, Paul

AU - Després, Jean Pierre

PY - 2018/3/27

Y1 - 2018/3/27

N2 - The prevalence of obesity has increased globally over the last 2 decades. Although the body mass index has been a convenient and simple index of obesity at the population level, studies have shown that obesity defined by body mass index alone is a remarkably heterogeneous condition with varying cardiovascular and metabolic manifestations across individuals. Adipose tissue is an exquisitely active metabolic organ engaged in cross-talk between various systems; perturbation of adipose tissue results in a pathological response to positive caloric balance in susceptible individuals that directly and indirectly contributes to cardiovascular and metabolic disease. Inadequate subcutaneous adipose tissue expansion in the face of dietary triglycerides leads to visceral and ectopic fat deposition, inflammatory/adipokine dysregulation, and insulin resistance. Conversely, preferential fat storage in the lower body depot may act as a metabolic buffer and protect other tissues from lipotoxicity caused by lipid overflow and ectopic fat. Translational, epidemiological, and clinical studies over the past 30 years have clearly demonstrated a strong link between visceral and ectopic fat and the development of a clinical syndrome characterized by atherogenic dyslipidemia, hyperinsulinemia/glucose intolerance, hypertension, atherosclerosis, and adverse cardiac remodeling/heart failure. This relationship is even more nuanced when clinical entities such as metabolically healthy obesity phenotype and the obesity paradox are considered. Although it is clear that the accumulation of visceral/ectopic fat is a major contributor to cardiovascular and metabolic risk above and beyond the body mass index, implementation of fat distribution assessment into clinical practice remains a challenge. Anthropometric indexes of obesity are easily implemented, but newer imaging-based methods offer improved sensitivity and specificity for measuring specific depots. Lifestyle, pharmacological, and surgical interventions allow a multidisciplinary approach to overweight/obesity that may improve outcomes and align with a public health message to combat the growing epidemic of obesity worldwide and to build healthier lives free of cardiovascular diseases.

AB - The prevalence of obesity has increased globally over the last 2 decades. Although the body mass index has been a convenient and simple index of obesity at the population level, studies have shown that obesity defined by body mass index alone is a remarkably heterogeneous condition with varying cardiovascular and metabolic manifestations across individuals. Adipose tissue is an exquisitely active metabolic organ engaged in cross-talk between various systems; perturbation of adipose tissue results in a pathological response to positive caloric balance in susceptible individuals that directly and indirectly contributes to cardiovascular and metabolic disease. Inadequate subcutaneous adipose tissue expansion in the face of dietary triglycerides leads to visceral and ectopic fat deposition, inflammatory/adipokine dysregulation, and insulin resistance. Conversely, preferential fat storage in the lower body depot may act as a metabolic buffer and protect other tissues from lipotoxicity caused by lipid overflow and ectopic fat. Translational, epidemiological, and clinical studies over the past 30 years have clearly demonstrated a strong link between visceral and ectopic fat and the development of a clinical syndrome characterized by atherogenic dyslipidemia, hyperinsulinemia/glucose intolerance, hypertension, atherosclerosis, and adverse cardiac remodeling/heart failure. This relationship is even more nuanced when clinical entities such as metabolically healthy obesity phenotype and the obesity paradox are considered. Although it is clear that the accumulation of visceral/ectopic fat is a major contributor to cardiovascular and metabolic risk above and beyond the body mass index, implementation of fat distribution assessment into clinical practice remains a challenge. Anthropometric indexes of obesity are easily implemented, but newer imaging-based methods offer improved sensitivity and specificity for measuring specific depots. Lifestyle, pharmacological, and surgical interventions allow a multidisciplinary approach to overweight/obesity that may improve outcomes and align with a public health message to combat the growing epidemic of obesity worldwide and to build healthier lives free of cardiovascular diseases.

KW - adiposity

KW - cardiac imaging techniques

KW - cardiovascular diseases

KW - obesity

KW - risk factors

KW - waist circumference

UR - http://www.scopus.com/inward/record.url?scp=85047299785&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047299785&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.117.029617

DO - 10.1161/CIRCULATIONAHA.117.029617

M3 - Article

C2 - 29581366

AN - SCOPUS:85047299785

VL - 137

SP - 1391

EP - 1406

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 13

ER -