Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation
- PMID: 36007112
- DOI: 10.1093/eurjpc/zwac187
Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation
Abstract
The ongoing obesity epidemic represents a global public health crisis that contributes to poor health outcomes, reduced quality of life, and >2.8 million deaths each year. Obesity is relapsing, progressive, and heterogeneous. It is considered a chronic disease by the World Obesity Federation (WOF) and a chronic condition by the World Heart Federation (WHF). People living with overweight/obesity are at greater risk for cardiovascular (CV) morbidity and mortality. Increased adiposity (body fat), particularly visceral/abdominal fat, is linked to CV risk and CV disease (CVD) via multiple direct and indirect pathophysiological mechanisms. The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy. Evidence indicates that intentional weight loss (particularly when substantial) lowers CVD risk among people with overweight/obesity. Long-term weight loss and maintenance require ongoing commitment from both the individual and those responsible for their care. This position paper, developed by the WOF and the WHF, aims to improve understanding of the direct and indirect links between overweight/obesity and CVD, the key controversies in this area and evidence relating to cardiometabolic outcomes with available weight management options. Finally, an action plan for clinicians provides recommendations to help in identifying and addressing the risks of obesity-related CVD (recognizing resource and support variances between countries).
Keywords: Adiposity; Cardiometabolic complications; Cardiovascular disease; Cardiovascular risk; Overweight; obesity.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
Conflict of interest statement
Conflict of interest: Professor Lopez-Jimenez has no relevant financial disclosures. Dr Wael Almahmeed has no relevant financial disclosures. Dr Harold Bays’ research site institution has received research grants from Alon Medtech/Epitomee, Amgen, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and Pfizer. Dr Harold Bays has served as a speaker for Novo Nordisk. Professor Ada Cuevas has received fees relating to conference and/or advisory board activities from Abbott, TEVA, Novo Nordisk, Merck and Saval. Professor Emanuele Di Angelantonio has no relevant financial disclosures. Professor Carel le Roux reports grants from the Irish Research Council, Science Foundation Ireland, Anabio and the Health Research Board. He served on advisory boards of Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson and Johnson, Sanofi Aventis, Astra Zeneca, Janssen, Bristol-Myers Squibb, Boehringer-Ingelheim and Keyron. Professor Naveed Sattar has consulted for Afimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, and Sanofi; and received grant support paid to his University from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics outside the submitted work. Dr Marie Chan Sun has no relevant financial disclosures. Professor Gary Wittert has received research support from Bayer, Lilly, Lawley Pharmaceuticals, Weight Watchers, ResMed Foundation, and Phillips. Speaker honoraria from Bayer, and Besins Healthcare. He is a member of an International and National Bayer advisory board. Professor Fausto Pinto has no relevant financial disclosures. Professor John PH Wilding undertakes consultancy and speaking engagements for industry contracted via the University of Liverpool (no personal payment) in relation to obesity and type 2 diabetes; in the last 2 years this includes work for Alnylam, AstraZeneca, Boehringer Ingelheim, Janssen Pharmaceuticals, Lilly, Napp, Novo Nordisk, Mundipharma, Pfizer, Rhythm Pharmaceuticals, Saniona and Ysopia (all modest). He is a named grant holder (at University of Liverpool) for research grants for clinical trials from AstraZeneca and Novo Nordisk (significant). He has received honoraria/lecture fees from AstraZeneca, Boehringer Ingelheim, Napp, Novo Nordisk, Mundipharma, Sanofi and Takeda (all modest).
Comment in
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Obesity and cardiovascular disease: beyond body weight and energy balance.Eur J Prev Cardiol. 2022 Dec 7;29(17):2216-2217. doi: 10.1093/eurjpc/zwac220. Eur J Prev Cardiol. 2022. PMID: 36136860 No abstract available.
