Obesity Duration and Cardiometabolic Disease

Abstract

Cardiovascular disease risk is known to be influenced by both the severity of a risk factor and the duration of exposure (eg, LDL [low-density lipoprotein] cholesterol, tobacco smoke). However, this concept has been largely neglected within the obesity literature. While obesity severity has been closely linked with cardiometabolic diseases, the risk of developing these conditions among those with obesity may be augmented by greater obesity duration over the life span. Few longitudinal or contemporary studies have investigated the influence of both factors in combination-cumulative obesity exposure-instead generally focusing on obesity severity, often at a single time point, given ease of use and lack of established methods to encapsulate duration. Our review focuses on what is known about the influence of the duration of exposure to excess adiposity within the obesity-associated cardiometabolic disease risk equation by means of summarizing the hypothesized mechanisms for and evidence surrounding the relationships of obesity duration with diverse cardiovascular and metabolic disease. Through the synthesis of the currently available data, we aim to highlight the importance of a better understanding of the influence of obesity duration in cardiovascular and metabolic disease pathogenesis. We underscore the clinical importance of aggressive early attention to obesity identification and intervention to prevent the development of chronic diseases that arise from exposure to excess body weight.

Keywords: cardiometabolic risk factors; diabetes mellitus; dyslipidemias; hypertension; obesity; vascular diseases chronic disease.

Figure 1.. Mechanistic pathways mediating the roles of both obesity/adiposity severity and duration in cardiovascular and metabolic disease pathogenesis.

This figure summarizes the available evidence from human translational and animal studies supporting the diverse roles for obesity severity and duration in the pathophysiology of various cardiovascular diseases and associated conditions affecting cardiovascular risk. Dysfunctional adipose tissue mediates the pathogenesis through numerous mechanisms. Less is known about potentially unique means through which obesity duration impacts the development of these disorders, and the potential for their resolution/improvement with weight loss. Created with BioRender.com. ASCVD, atherosclerotic cardiovascular disease; RAAS, renin-angiotensin- aldosterone system