Obesity as a Cardiovascular Risk Factor
James R. Sowers
8 December 2003, Volume 115, Issue 8 (Supplement 1) Pages 37-41
Costs of Caring for Obese Add Up
The prevalence of overweight and obesity continues to increase rapidly in the United States, with more than half of all adults currently overweight or obese. In general, people become obese because of a combination of inherited genes and a lifestyle consisting of low levels of physical activity and
poor choices of foods and food combinations along with consumption of excess calories. Obesity,
especially the central or visceral type, is a predisposing factor for the development of type 2 diabetes mellitus, hypertension, and cardiovascular disease (CVD). Obesity and type 2 diabetes are associated with insulin resistance. The relation among obesity, insulin resistance, and CVD appears to develop at a relatively young age. Central obesity is linked with hyperinsulinemia,
insulin resistance, dyslipidemia, and proinflammatory and prothrombotic clinical states. Adipose tissue synthesizes and secretes biologically active molecules that may affect CVD risk factors.
These chemical messengers include adiponectin, resistin, leptin, plasminogen activator
inhibitor–1, tumor necrosis factor–α, and interleukin-6. In overweight and obese individuals, weight loss may improve insulin sensitivity, leading to reduction in risk factors for CVD and, consequently, the potential for cardiovascular events. Agents that improve insulin sensitivity, such as the thiazolidinediones, have been shown to reduce visceral obesity. Decreases in visceral
adipose tissue contribute to improvements in insulin sensitivity and blood pressure, and weight loss reduces serum levels of triglycerides and low-density lipoprotein cholesterol while increasing serum levels of high-density lipoprotein cholesterol. Reduction of risk factors suggests that the development of cardiovascular disease will be reduced by the improvement of insulin
sensitivity and weight loss.
Supported by Grant No. RO1-HL-63904-01 from the National Institutes of Health, Grant No. 0018 from the Department of Veterans Affairs Merit System, and Grant No. RA0095 from the American Diabetes Association.
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