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
N1 - Funding Information:
Dr Neeland is supported by grant K23 DK106520 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases and by the Dedman Family Scholarship in Clinical Care at the University of Texas Southwestern Medical Center.
Funding Information:
Dr Neeland has received honoraria, consulting/speaking fees, and other research support from Boehringer-Ingelheim and a research grant from Novo Nordisk and is a member of the scientific advisory board of Advanced MR Analytics. Dr Poirier has received honoraria and consulting/speaking fees from Abbott Vascular, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck, Novo Nordisk, Pfizer, Roche, Sanofi-Aventis, Servier, and Valeant. Dr Després is the scientific director of the International Chair on Car-diometabolic Risk, which is supported by the “Fondation de l’Université Laval.”
Funding Information:
Dr Neeland is supported by grant K23 DK106520 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases and by the Dedman Family Scholarship in Clinical Care at the University of Texas Southwestern Medical Center. Dr Després’s work has been supported by the Canadian Institutes of Health Research and by the “Fondation de l’Institut Uni-versitaire de Cardiologie et de Pneumologie de Québec–Université Laval.”
Publisher Copyright:
© 2018 American Heart Association, Inc.
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
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U2 - 10.1161/CIRCULATIONAHA.117.029617
DO - 10.1161/CIRCULATIONAHA.117.029617
M3 - Article
C2 - 29581366
AN - SCOPUS:85047299785
SN - 0009-7322
VL - 137
SP - 1391
EP - 1406
JO - Circulation
JF - Circulation
IS - 13
ER -