In the recent clinical consensus statement by the European Society of Cardiology (ESC) published in the European Heart Journal, researchers highlight the association between obesity and cardiovascular disease (CVD).

Obesity has grown dramatically during the last four decades, impacting over a billion individuals and leading to chronic diseases. CVD is the cause of obesity-related increased mortality.

Obesity, despite its link, is underrecognized and undertreated. Population-based and tailored treatments are required to prevent excess weight and lower the global obesity burden.

Study: Obesity and cardiovascular disease: an ESC clinical consensus statement. Image Credit: Lee Charlie/Shutterstock.com

About the consensus statement

The present consensus statement highlights the impact of obesity on CVD.

Causal factors and cardiovascular consequences of obesity

Obesity involves calorie intake that exceeds energy expenditure. Genetic and neurobiological factors impact individual obesity development; however, environmental and societal factors largely contribute to obesity.

Underlying mechanisms include brain-based control of hunger and satiety. Metrics of abdominal obesity, such as waist circumference, waist-to-height ratio, and waist-to-hip ratio, might help clarify cardiometabolic risk classification beyond body mass index (BMI).

Obesity raises the risk of CVD by increasing risk factors such as diabetes, dyslipidemia, and obstructive sleep apnea. Obesity increases the risk of atherosclerosis, coronary artery disease, and peripheral arterial and cerebrovascular disease.

High BMI can cause heart failure with preserved ejection fraction (HFpEF), heart failure with decreased ejection fraction (HFrEF), atrial fibrillation, or sudden cardiac death. Other obesity-related complications include deep vein thrombosis (DVT), pulmonary embolism, and aortic valve stenosis.

Obesity increases fluid retention and blood volume, particularly in adipose tissue, resulting in increased cardiac output and venous return. Renal alterations, such as increased intrarenal blood pressure and an increase in plasma renin, angiotensin-converting enzyme (ACE), angiotensinogen, aldosterone, and angiotensin II activity, mediate obesity-related hypertension.

Other factors are obstructive sleep apnea, supranormal sympathetic nerve activation, hyperleptinemia, and insulin resistance. Obesity increases the amount of neck adipose tissue, limiting the size of the pharyngeal airway lumen and raising the risk of airway collapse when asleep.

Obesity is related to an atherogenic lipoprotein profile, including elevated triglyceride, apolipoprotein B, low-density lipoprotein-cholesterol (LDL), and reduced high-density lipoprotein cholesterol (HDL-C). Visceral adiposity is related to atherosclerosis development, involving low-grade inflammation.

Obesity-related heart failure includes increased ventricular remodeling, plasma volume expansion, pericardial constraint, ventricular interdependence, and poorer vasodilation and exercise capacity.

 

ESC guidelines to manage obesity and cardiovascular disease

Diabetes patients who are overweight or obese should lose weight and exercise more to improve metabolic control and their CVD risk profile. ESC recommends a constant BMI between 20 and 25 kg per square meter and a waist circumference below 94 cm among males and below 80 cm among females.

Patients with obesity or prediabetes should receive antihypertensive medication if their blood pressure in the clinic is 140/90 mm of Hg or above, 130 to 139/80 to 89 mm of Hg, and they have an estimated 10-year CVD risk of ≥10%, even after lifestyle-related treatment for three months.

Apolipoprotein B analysis is indicated for risk assessment in obese individuals as an alternative to LDL-C for dyslipidemia screening, diagnosis, and medication.

Obese people should get regular non-restorative sleep screenings. The ESC advises at least 150-300 minutes of moderate or 75-150 minutes of vigorous physical activity per week to reduce all-cause mortality, CV mortality, and morbidity, with strength training added two to three times per week.

To lose weight, type 2 diabetes patients who are overweight or obese should use glucose-lowering drugs such as glucose-lowering peptide-1 receptor agonists (GLP-1RAs). GLP-1RAs with proven cardiovascular effects, such as liraglutide, semaglutide s.c., dulaglutide, and efpeglenatide, are indicated for type 2 diabetes patients with atherosclerosis to minimize cardiovascular events.

Orlistat and bupropion of naltrexone should be used cautiously in patients with established cardiovascular disease due to their limited effects, lack of data on cardiovascular safety, and concerns regarding long-term cardiovascular disease risk.

Weight loss should include lifetime physical activity and healthy eating habits, with individualized nutritional advice based on individual objectives. Dietary therapies should limit calorie and ultra-processed food intake, control portion sizes, and increase fruit and vegetable consumption.

High-protein diets maintain lean muscle mass and increase satiety. Multimodal therapies may be delivered in groups, individually, or through technology.

Based on the findings, obesity is a common problem among individuals with cardiovascular disease, influencing the course and prognosis of their illness. It increases the risk of heart failure, atrial fibrillation, venous thromboembolism, and aortic stenosis.

Obesity is responsible for two-thirds of all fatalities associated with high BMI. Weight loss by diet, exercise, and pharmaceuticals can lower CVD risk.

Cardiologists must conduct obesity screening and encourage individuals to reduce weight to improve their quality of life. Health efforts must prioritize primary prevention and management of obesity to reduce the risk of cardiovascular disease and related complications.