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Posted on: June 25th, 2021

Over the past several decades, obesity has become an epidemic, leading to a massive rise in heart disease, the leading cause of death worldwide.

Recently, a scientific statement published in Circulation, a committee assembled the latest clinical data aimed to inform practice regarding markers for CV outcomes in patients with obesity, published this in regard to the direct link between obesity and CVD:

“This scientific statement provides the most recent research and information on the relationship between obesity and obesity treatment in coronary heart disease, heart failure and arrhythmias,” Tiffany M. Powell-Wiley, MD, MPH, FAHA, a Stadtman tenure-track investigator and chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory in the division of intramural research at the NHLBI and chair of the writing committee, said in a press release. “The timing of this information is important because the obesity epidemic contributes significantly to the global burden of cardiovascular disease and numerous chronic health conditions that also impact heart disease.”

Dr. Powell’s statement identifies the cause for concern over the relationship between obesity and CVD. Obesity usually relies on body mass index for diagnoses, but this was not good enough for the committee. The proposal was to use waist circumference among individuals with normal body weight to conduct a new study. This was due to the connection between abdominal fat and CVD.

The Circulation statement also referenced the data that suggests metabolically healthy obesity may be a phenotype for many people. Comparing individuals with metabolically healthy obesity to those with excess adipose tissue (the highest-risk obesity group) shows that BMI may not be the best indicator for unhealthy obesity.

“Epicardial adipose tissue represents visceral fat between the outer wall of the myocardium and the visceral layer of the pericardium,” the committee wrote. “This adipose tissue originates from embryonic brown adipose tissue and releases cytokines and chemokines into the vasculature. It has been associated with overall cardiovascular health score and arterial stiffness in patients with CVD and type 2 diabetes.”

Weight Loss and CAD in Obesity

More information in the statement from The Circulation notes that trials have shown that 3-5 exercise sessions per week for 12-52 weeks can reduce unhealthy obese tissue substantially (compared to a no-exercise routine). Further, weight loss was not an absolute requirement for reducing visceral adipose tissue. One exercise intervention meta-analysis noted a 6.1% loss of visceral adipose tissue with no weight loss.

“Lifestyle modification, with associated weight loss, improves both the diagnostic components of metabolic syndrome and associated pathophysiologic abnormalities such as systemic inflammation and endothelial dysfunction. Interventional trials of medical weight loss have not demonstrated a clear reduction in CAD rates.”

The Circulation committee also stated that the reason for the wide range of results between surgical and nonsurgical methods of weight loss was associated with the degree of weight loss achieved and the risk factor reduction observed among patients who underwent bariatric surgery.

Recommendations for Future Research

The committee made the following recommendations for future research in the area of obesity and CV health:

  • “Conduct randomized controlled trials that assess the role of weight loss and lower visceral adiposity in improving CVD outcomes.”
  • “Develop dietary interventions with randomized controlled trials to determine healthful dietary patterns or personalized diets for patients with obesity for CV risk reduction.”
  • “Develop upstream interventions for primary prevention and better treatment of obesity as a chronic disease among young patients.”
  • “Identify best practices for use of GLP-1 receptor agonists and SGLT2 inhibitors to reduce HF hospitalization and CV death in HF with reduced ejection fraction and HF with preserved EF with and without diabetes.”
  • “Develop strategies for weight maintenance and improved functional outcomes as opposed to weight-loss interventions in older populations at risk for HF.”

The final statement in the committee’s article says:

“As overweight and obesity prevalence increases among adolescents worldwide, it is critical to address how best to develop upstream primary prevention interventions and better treatment strategies, particularly for young patients with severe obesity.”

Research at Biofortis

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