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Obesity and the Cardiometabolic Syndrome: Impact on Chronic Kidney Disease and CVD

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Cardiovascular Disease in Racial and Ethnic Minorities

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

The prevalence of the cardiometabolic syndrome (CMS), a cluster of cardiovascular disease (CVD) risk factors which include central obesity, dysglycemia, atherogenic dyslipidemia, hypertension (hypertension), and microalbuminuria (MAU), has increased. Obesity largely drives the dramatic increase in the incidence and prevalence of the CMS worldwide. Recently there has been increasing interest in the association between CMS, obesity, and chronic kidney disease (CKD), which is multifactorial and includes genetic as well as environmental factors. Obesity, hypertension, and dysglycemia are strongly associated with a systemic chronic low-grade inflammation, inappropriate activation of the renin–angiotensin–aldosterone system (RAAS), and increased oxidative stress. The link between RAAS activation and oxidative stress has been a subject of great interest over the past several years.

African-Americans have a greater prevalence of other cardiovascular risk factors, especially obesity and hypertension. There is a question as to whether race or ethnicity should be a significant consideration in the choice of individual antihypertensive drugs, specifically for monotherapy or the use of combination antihypertensive drug therapy. Microalbuminuria is currently recognized as an independent risk factor for progressive CKD and CVD in individuals with type 2 diabetes. Visceral obesity, which by definition is the excess fat tissue in paraintestinal and omental areas, is a feature strongly associated with the CMS and increased risk of CVD. Patients with hypertension have higher fasting and post-prandial insulin levels and evidence of insulin resistance, independent of body mass index or body fat distribution. Both insulin resistance and hypertension predispose to atherosclerosis. Hypertension is a pathophysiologic stimulus for NADPH oxidase complex activation.

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Authors and Affiliations

  1. Department of Internal Medicine, Endocrinology and Diabetes Division, University of Missouri Columbia, Harry S Truman VA Hospital, Columbia, MO, USA

    Abrar Ahmed MD, Guido Lastra MD, Camila Manrique MD & James R Sowers MD

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  1. Abrar Ahmed MD
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  2. Guido Lastra MD
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  3. Camila Manrique MD
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  4. James R Sowers MD
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Editors and Affiliations

  1. Cardiology Division, Emory University, 5355 Hunter Road, Atlanta, GA, 30349, USA

    Keith C. Ferdinand MD

  2. Department of Internal Medicine, New Hanover Regional Medical Center, 212 Walnut Street, Wilmington, NC, 28401 #101, USA

    Annemarie Armani MD

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Ahmed, A., Lastra, G., Manrique, C., Sowers, J.R. (2009). Obesity and the Cardiometabolic Syndrome: Impact on Chronic Kidney Disease and CVD. In: Ferdinand, K.C., Armani, A. (eds) Cardiovascular Disease in Racial and Ethnic Minorities. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-410-0_10

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  • DOI: https://doi.org/10.1007/978-1-59745-410-0_10

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