Trends in Obesity and Risk of Cardiovascular Disease
- 9 Downloads
Purpose of Review
The obesity epidemic is a global health crisis of staggering proportion. Excess body weight is a major risk factor for the development of cardiovascular disease (CVD). We review temporal trends in obesity rates, pertinent pathophysiology to understand mechanisms of disease, and treatment strategies in the context of reducing cardiovascular risk.
The prevalence of obesity is increasing in recent decades and is driven by a complex interplay of economic, environmental, and biological factors. In developed countries, changes in food intake, such as increased consumption of energy-dense and added sugar, have contributed significantly to weight gain. Single nucleotide variations in genes and alterations in the gut microbiome have been associated with the obese phenotype. The description of an obesity paradox in patients with CVD may have several explanations, including limitations of body mass index (BMI) to assess adiposity, selection bias, and lead-time bias with earlier onset of disease. Evidence-based treatments for weight loss include lifestyle intervention, pharmacotherapy, and bariatric surgery. Data on the long-term effects of these therapies on cardiovascular risk are limited.
Overweight and obesity are associated with increased cardiovascular morbidity and mortality over the lifespan. Despite our increasing understanding of biological and environmental drivers of obesity, more work is needed in developing effective prevention strategies and implementation of evidence-based treatments to promote cardiovascular health and reduce cardiovascular risk. Ultimately, efforts to prevent and postpone cardiovascular morbidity should include focus on maintenance of normal BMI (primordial prevention) for a longer and healthier life, free of CVD.
KeywordsOverweight Obesity Cardiovascular disease risk
Compliance with Ethical Standards
Conflict of Interest
Ryan Lahey declares no conflicts of interest and Sadiya S. Khan reports grants from NIH/NHBLI, during the conduct of the study.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. 2015;219:1–8.Google Scholar
- 3.• Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. JAMA. 2016;315(21):2292–9. Report on increasing obesity prevalence in recent decades among the US pediatric population. CrossRefPubMedGoogle Scholar
- 6.• Khan SS, Ning H, Wilkins JT, Allen N, Carnethon M, Berry JD, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3(4):280–7. A large-scale population-based study demonstrating increased CVD morbidity and mortality associated with overweight and obesity. CrossRefPubMedGoogle Scholar
- 9.Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586–613.CrossRefPubMedGoogle Scholar
- 11.Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;288:1–8.Google Scholar
- 14.USDA Economic Research Service. Food calories and macronutrients per capita per day. United States Department of Agriculture: Center for Nutrition Policy and Promotion. 2014. https://www.cnpp.usda.gov/USFoodSupply-1909-2010. Accessed 25 May 2018.
- 36.• Shungin D, Winkler TW, Croteau-Chonka DC, Ferreira T, Locke AE, Mägi R, et al. New genetic loci link adipose and insulin biology to body fat distribution. Nature. 2015;518(7538):187–96. Through GWASs, identified numerous novel loci associated with visceral adiposity shedding new light on underlying pathophysiological mechanisms. CrossRefPubMedPubMedCentralGoogle Scholar
- 43.• Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E, et al. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med. 2016;374(25):2430–40. A population-based study which found an association between elevated BMI in adolescence and cardiovascular mortality later in adulthood. CrossRefPubMedGoogle Scholar
- 46.Iliodromiti S, Celis-Morales CA, Lyall DM, Anderson J, Gray SR, Mackay DF, et al. The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296,535 adults of white European descent. Eur Heart J. 2018;39(17):1514–20.CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Sam S. Differential effect of subcutaneous abdominal and visceral adipose tissue on cardiometabolic risk. Horm Mol Biol Clin Investig. 2018;33 https://doi.org/10.1515/hmbci-2018-0014.
- 53.Vasan SK, Osmond C, Canoy D, Christodoulides C, Neville MJ, Di Gravio C, et al. Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk. Int J Obesity (Lond). 2018;42(4):850–7.CrossRefGoogle Scholar
- 60.111th Congress (2009–2010). H.R.3590: Patient Protection and Affordable Care Act. https://www.congress.gov/bill/111th-congress/house-bill/3590. Accessed 25 May 2018.
- 61.Wang Y, Wu Y, Wilson RF, Bleich S, Cheskin L, Weston C, et al. Childhood obesity prevention programs: comparative effectiveness review and meta-analysis. Rockville: AHRQ Comparative Effectiveness Reviews; 2013.Google Scholar
- 62.Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the obesity society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.CrossRefPubMedGoogle Scholar
- 66.LeFevre ML. US preventive services task force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. preventive services task force recommendation statement. Ann Intern Med. 2014;161(8):587–93.CrossRefPubMedGoogle Scholar
- 68.Dunkley AJ, Charles K, Gray LJ, Camosso-Stefinovic J, Davies MJ, Khunti K. Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta-analysis. Diabetes Obes Metab. 2012;14(7):616–25.CrossRefPubMedGoogle Scholar
- 72.Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159–91.CrossRefPubMedGoogle Scholar
- 73.American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers, 2011–2016. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed 25 May 2018.
- 74.• Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65. The first study to demonstrate cardiovascular benefit of bariatric surgery, conducted in a small Swedish population. CrossRefPubMedGoogle Scholar