From the Guidelines
Central or abdominal obesity carries the highest cardiovascular risk among obesity types. This is due to the metabolically active visceral fat that accumulates around the abdomen and visceral organs, releasing inflammatory cytokines and hormones that directly contribute to insulin resistance, dyslipidemia, and hypertension 1. The assessment of body fat distribution can be performed in a simple manner by measuring the waist and hip circumference to calculate the waist-to-hip ratio, with central obesity and greater amounts of visceral fat conveying the highest mortality risk in patients with CAD 1.
Some key points to consider include:
- The presence of metabolic syndrome, which is defined as the coexistence of several interrelated conditions, including central obesity, hyperglycemia, elevated systemic BP, hypertriglyceridemia, and decreased HDL, increases the risk for cardiovascular events 1.
- Visceral fat increases systemic inflammation and oxidative stress, further damaging blood vessels and promoting atherosclerosis.
- Weight loss interventions should specifically target reduction in waist circumference through a combination of caloric restriction, increased physical activity, and possibly medications like GLP-1 receptor agonists if appropriate.
- Even modest reductions in abdominal fat can significantly improve metabolic parameters and reduce cardiovascular risk.
The diagnosis of obesity is typically made using the body mass index (BMI), but recent studies have challenged the accuracy of BMI in detecting body adiposity, particularly in patients with established CAD 1. Therefore, measuring waist circumference and calculating the waist-to-hip ratio is crucial in assessing the risk of cardiovascular disease in obese patients.
From the Research
Types of Obesity and Cardiovascular Risk
- Android obesity, also known as visceral obesity, is characterized by fat accumulation in the abdominal area and is associated with a higher risk of cardiovascular disease compared to gynecoid obesity, which is characterized by fat accumulation in the hips and thighs 2.
- Studies have shown that android obesity is linked to metabolic anomalies, such as insulin resistance, dyslipidemia, and hypertension, which are also characteristic of the metabolic syndrome 2, 3.
- The distribution of fat in the body, rather than just the overall level of adiposity, may influence the risk of cardiovascular disease, with android fat distribution being associated with a higher risk of cardiovascular disease 3, 4.
Cardiovascular Risk Factors Associated with Android Obesity
- Android obesity is associated with impaired glucose tolerance and insulin resistance, which can increase the risk of developing type 2 diabetes and cardiovascular disease 5, 3.
- Individuals with android obesity are also more likely to have dyslipidemia, characterized by high levels of triglycerides and low levels of high-density lipoprotein (HDL) cholesterol, which can increase the risk of cardiovascular disease 5, 3.
- Endothelial dysfunction, which is characterized by impaired blood vessel function, is also more common in individuals with android obesity, which can increase the risk of cardiovascular disease 3.
Impact of Android Obesity on Cardiovascular Disease
- Android obesity is an independent risk factor for cardiovascular disease, and is associated with an increased risk of cardiovascular mortality 4.
- The risk of cardiovascular disease associated with android obesity can be reduced through lifestyle modification, such as weight loss and increased physical activity, as well as through surgical interventions, such as bariatric surgery 4.