Obesity and cardiovascular health

Abstract

Obesity has risen to epidemic levels worldwide over the past few decades and has become a huge global health burden owing to its direct contribution to the development of some of the most prevalent chronic diseases including diabetes, hypertension, hyperlipidaemia, and other cardiovascular diseases. Obesity is a disease of positive energy balance resulting from complex interactions between abnormal neurohumoral responses and an individual's socioeconomic, environmental, behavioural, and genetic factors leading to a state of chronic inflammation. Understanding the complex nature of the disease is crucial in determining the best approach to combat its rising numbers. Despite recent advancements in pharmacological therapy for the treatment of obesity, reversing weight gain and maintaining weight loss is challenging due to the relapsing nature of the disease. Prevention, therefore, remains the key which needs to start in utero and continued throughout life. This review summarizes the role obesity plays in the pathophysiology of various cardiovascular diseases both by directly affecting endothelial and myocyte function and indirectly by enhancing major cardiovascular risk factors like diabetes, hypertension, and hyperlipidaemia. We highlight the importance of a holistic approach needed to prevent and treat this debilitating disease. Particularly, we analyse the effects of plant-based diet, regular exercise, and non-exercise activity thermogenesis on obesity and overall cardiorespiratory fitness. Moreover, we discuss the significance of individualizing obesity management with a multimodal approach including lifestyle modifications, pharmacotherapy, and bariatric surgery to tackle this chronic disease.

Keywords: Adiposity; Cardiopulmonary fitness; Cardiovascular disease; Healthy lifestyle; Heart disease risk factors; Holistic health; Obesity; Overweight.

Graphical Abstract

Figure 1

Mechanisms involved in the pathogenesis of obesity-related hypertension. RAAS, renin–angiotensin–aldosterone system; SNS, sympathetic nervous system. Reproduced from Shariq and McKenzie.

Figure 2

Adjusted hazard ratios and 95% confidence intervals for incident cardiovascular disease, according to the continuous overall plant-based diet index. The histogram shows the distribution of scores for the plant-based diet index in grey. The solid lines represent the adjusted hazard ratios for incident cardiovascular disease, modelled using two linear spline terms with one knot at the 12.5th percentile of plant-based diet index (score, 44), which was used as the reference point. The dashed lines represent the 95% confidence intervals. ‘Reproduced from Kim et al.