Strategies and methods for the correction of obesity and associated cardiovascular risk
https://doi.org/10.15829/1560-4071-2019-4-61-67
Abstract
Today, there is a need to study obesity from the perspective of associated with it cardiovascular risk correcting. Future researches will have to study the pathophysiology of adipose tissue in greater detail, including tissue, cellular and molecular levels, in order to develop the most effective strategies for therapeutic and preventive measures. At the same time, taking into account the basic ideas about the role of cardiorespiratory fitness in the etiopathogenesis of cardiovascular diseases, the ratio of fat free and fat mass, white and brown adipose tissue, subcutaneous fat and visceral adipose tissue, main directions of these measures becomes obvious. This article discusses strategies for correcting obesity and associated cardiovascular risk as part of primary and secondary prevention of cardiovascular diseases and suggests an algorithm for developing an individual program of preventive measures for an obese patient.
About the Authors
T. Yu. Kuznetsova
Petrozavodsk State University
Russian Federation
Petrozavodsk
Russian Federation
Petrozavodsk
M. A. Druzhilov
Petrozavodsk State University
Russian Federation
Petrozavodsk
Russian Federation
Petrozavodsk
G. A. Chumakova
Altai State Medical University;
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Barnaul, Kemerovo
Russian Federation
Barnaul, Kemerovo
N. D. Veselovskaya
Altai State Medical University;
Research Institute for Complex Issues of Cardiovascular Diseases;
Altai Regional Cardiologic Dispensary
Russian Federation
Barnaul, Kemerovo
Russian Federation
Barnaul, Kemerovo
References
1. The GBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377:13-27. doi:10.1056/NEJMoa1614362.
2. Neeland I, Poirier P, Després J. Cardiovascular and Metabolic Heterogeneity of Obesity Clinical Challenges and Implications for Management. Circulation. 2018;137:1391-406. doi:10.1161/CIRCULATIONAHA.117.029617.
3. Zarzour A, Kim H, Weintraub N. Understanding Obesity-Related Cardiovascular Disease. It’s All About Balance. Circulation. 2018;138:64-6. doi:10.1161/CIRCULATIONAHA.118.034454.
4. Chumakova GA, Kuznetsova TY, Druzhilov MA, et al. Visceral adiposity as a global factor of cardiovascular risk. Russ J Cardiol. 2018;5:7-14. (In Russ.) doi:10.15829/1560-4071-2018-5-7-14.
5. Druzhilov MA, Kuznetsova ТY, Druzhilova ОY. “Obesity paradoxes”: main causes of an “inverse” cardiovascular epidemiology. Cardiovascular Therapy and Prevention. 2018;17(5):92-8. (In Russ.) doi:10.15829/1728-8800-2018-5-92-98.
6. Bays H. Adiposopathy: is “sick fat” a cardiovascular disease? J Am Coll Cardiol. 2011;57:2461-73. doi:10.1016/j.jacc.2011.02.038.
7. Kim S, Despres J, Koh K. Obesity and cardiovascular disease: friend or foe? Eur Heart J. 2016;37(48):3560-8. doi:10.1093/eurheartj/ehv509.
8. Kushner R. Weight loss strategies for treatment of obesity. Prog Cardiovasc Dis. 2014;56:465-72. doi:10.1016/j.pcad.2013.09.005.
9. Warkentin L, Das D, Majumdar S, et al. The effect of weight loss on health-related quality of life: systematic review and meta-analysis of randomized trials. Obes Rev. 2014;15:169-82. doi:10.1111/obr.12113.
10. Lavie C, Arena R, Alpert M, et al. Management of cardio-vascular diseases in patients with obesity. Nat Rev Cardiol. 2018;15(1):45-56. doi:10.1038/nrcardio.2017.108.
11. Pack Q, Rodriguez-Escudero J, Thomas R et al. The prognostic importance of weight loss in coronary artery disease: a systematic review and meta-analysis. Mayo Clin Proc. 2014;89:1368-77. doi:10.1016/j.mayocp.2014.04.033.
12. Lavie C, Arena R, Swift D, et al. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res 2015;117(2):207-19. doi:10.1161/CIRCRESAHA.117.305205.
13. Prado C, Wells J, Smith S, et al. Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr. 2012;31(5):583-601. doi:10.1016/j.clnu.2012.06.010.
14. Tian S, Xu Y. Association of sarcopenic obesity with the risk of all-cause mortality: a meta-analysis of prospective cohort studies. Geriatr Gerontol Int. 2016;16(2):155-66. doi:10.1111/ggi.12579.
15. De Schutter A, Lavie C, Kachur S, et al. Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox. Mayo Clin Proc. 2014;89(8):1072-9. doi:10.1016/j.mayocp.2014.04.025.
16. Carbone S, Lavie C, Arena R. Obesity and Heart Failure: Focus on the Obesity Paradox. Mayo Clin Proc. 2017;92(2):266-79. doi:10.1016/j.mayocp.2016.11.001.
17. Barry V, Baruth M, Beets M, et al. Fitness vs. fatness on all-cause mortality: a metaanalysis. Prog Cardiovasc Dis. 2014;56:382-90. doi:10.1016/j.pcad.2013.09.002.
18. Druzhilov MA, Kuznetsova TY. Obesity associated atrial fibrillation: epicardial fat tissue in etiopathogenesis. Russ J Cardiol. 2017;7:178-84. (In Russ.) doi:10.15829/1560-4071-2017-7-178-184.
19. Despres J. Obesity and cardiovascular disease: weight loss is not the only target. Can J Cardiol. 2015;31:216-22. doi:10.1016/j.cjca.2014.12.009.
20. González N, Moreno-Villegas Z, González-Bris A, et al. Regulation of visceral and epicardial adipose tissue for preventing cardiovascular injuries associated to obesity and diabetes. Cardiovasc Diabetol. 2017;16(1):44. doi:10.1186/s12933-017-0528-4.
21. Kim S, Plutzky J. Brown Fat and Browning for the Treatment of Obesity and Related Metabolic Disorders. Diabetes Metab J. 2016;40:12-21. doi:10.4093/dmj.2016.40.1.12.
22. Dias S, Paredes S, Ribeiro L. Drugs Involved in Dyslipidemia and Obesity Treatment: Focus on Adipose Tissue. International Journal of Endocrinology. 2018;Article ID 2637418. doi:10.1155/2018/2637418.
23. Kim M, Tomita T, Kim M, et al. Aerobic exercise training reduces epicardial fat in obese men. J Appl Physiol. 2009;106:5-11. doi:10.1152/japplphysiol.90756.2008.
24. Borel A, Nazare J, Baillot A, et al. Cardiometabolic risk improvement in response to a 3-yr lifestyle modification program in men: contribution of improved cardiorespiratory fitness vs. weight loss. Am J Physiol Endocrinol. 2017;312:273-81. doi:10.1152/ajpendo.00278.2016.
25. Verheggen R, Maessen M, Green D, et al. A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev. 2016;17:664-90. doi:10.1111/obr.12406.
26. Hayashino Y, Jackson J, Hirata T, et al. Effects of exercise on C-reactive protein, inflammatory cytokine and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metab Clin Exp. 2014;63(3):431-40. doi:10.1016/j.metabol.2013.08.018.
27. Jennersjö P, Ludvigsson J, Länne T, et al. Pedometer-determined physical activity is linked to low systemic inflammation and low arterial stiffness in type 2 diabetes. Diabet Med. 2012;29(9):1119-25. doi:10.1111/j.1464-5491.2012.03621.x.
28. Stegenga H, Haines A, Jones K, et al. Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance. BMJ. 2014;349:g6608. doi:10.1136/bmj.g6608.
29. Gremeaux V, Drigny J, Nigam A, et al. Long-term lifestyle intervention with optimized highintensity interval training improves body composition, cardiometabolic risk, and exercise parameters in patients with abdominal obesity. Am J Phys Med Rehabil. 2012;91(11):941- 50. doi:10.1097/PHM.0b013e3182643ce0.
30. Artero E, Lee D, Lavie C, et al. Effects of muscular strength on cardiovascular risk factors and prognosis. J Cardiopulm Rehabil Prev. 2012;32(6):351-8. doi:10.1097/HCR.0b013e3182642688.
31. Piepoli М, Hoes А, Agewall S, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2016). European Heart Journal. 2016;37(29):2315- 81. doi:10.1016/j.atherosclerosis.2016.05.037.
32. Anderson C. Dietary Patterns to Reduce Weight and Optimize Cardiovascular Health Persuasive Evidence for Promoting Multiple, Healthful Approaches. Circulation. 2018;137:1114-6. doi:10.1161/CIRCULATIONAHA.117.031429.
33. Sakamoto T, Takahashi N, Goto T, et al. Dietary factors evoke thermogenesis in adipose tissues. Obes Res Clin Pract. 2014;8(6):533-9. doi:10.1016/j.orcp.2013.12.002.
34. Apovian C, Aronne L, Bessesen D, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100:342-62. doi:10.1210/jc.2014-3415.
35. Smith S, Stenlof K, Greenway F, et al. Orlistat 60 mg reduces visceral adipose tissue: a 24-week randomized, placebo-controlled, multicenter trial. Obesity (Silver Spring). 2011;19(9):1796-803. doi:10.1038/oby.2011.143.
36. Dedov II, Melnichenko GA, Romantsova TI. The strategy of obesity management: the results of All-Russian observational program “Primavera”. Obesity and Metabolism. 2016;13(1):36-44. (In Russ.) doi:10.14341/OMET2016136-44.
37. Pi-Sunyer X, Astrup A, Fujioka K, et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med. 2015;373:11-22. doi:10.1056/NEJMoa1411892.
38. Iacobellis G, Mohseni M, Bianco S, et al. Liraglutide causes large and rapid epicardial fat reduction. Obesity. 2017; 25:311-6. doi:10.1002/oby.21718.
39. Beiroa D, Imbernon M, Gallego R et al. GLP-1 agonism stimulates brown adipose tissue thermogenesis and browning through hypothalamic AMPK. Diabetes. 2014;63:3346-58. doi:10.2337/db14-0302.
40. El Bekay R, Coín-Aragüez L, Fernández-García D et al. Effects of glucagon-like peptide-1 on the differentiation and metabolism of human adipocytes. Br J Pharmacol. 2016;173(11):1820-34. doi:10.1111/bph.13481.
41. Vijgen G, Bouvy N, Teule G, et al. Increase in brown adipose tissue activity after weight loss in morbidly obese subjects. J Clin Endocrinol Metab. 2012;97:1229-33. doi:10.1210/jc.2012-1289.
42. Rodriguez-Flores M, Aguilar-Salinas C, Piché M, et al. Effect of bariatric surgery on heart failure. Expert Rev Cardiovasc Ther. 2017;15:567-79. doi:10.1080/14779072.2017.1352471.
43. Quintero-Castillo D, Luz-Araujo H, Guerra-Velázquez M, et al. Lipid profile in obese and non-obese women with polycystic ovary syndrome treated with metformin. Endocrinol Nutr. 2010;57:262-7. doi:10.1016/j.endonu.2010.04.001.
44. Lima-Martínez M, Paoli M, Rodney M, et al. Effect of sitagliptin on epicardial fat thickness in subjects with type 2 diabetes and obesity: a pilot study. Endocrine. 2016;51(3):448-55. doi:10.1007/s12020-015-0710-y.
45. Neeland I, McGuire D, Chilton R, et al. Empagliflozin reduces body weight and indices of adipose distribution in patients with type 2 diabetes mellitus. Diab Vasc Dis Res. 2016;13(2):119-26. doi:10.1177/1479164115616901.
46. Fukuda Т, Bouchi R, Terashima М, et al. Ipragliflozin Reduces Epicardial Fat Accumulation in Non-Obese Type 2 Diabetic Patients with Visceral Obesity: A Pilot Study. Diabetes Ther. 2017;8:851-61. doi:10.1007/s13300-017-0279-y.
47. Dıaz-Rodrıguez E, Agra R, Fernandez A, et al. Effects of dapagliflozin on human epicardial adipose tissue: modulation of insulin resistance, inflammatory chemokine production, and differentiation ability. Cardiovascular Research. 2018;114:336-46. doi:10.1093/cvr/cvx186.
48. Alexopoulos N, Melek B, Arepalli C, et al. Effect of intensive versus moderate lipidlowering therapy on epicardial adipose tissue in hyperlipidemic post-menopausal women: a substudy of the BELLES trial. J Am Coll Cardiol. 2013;61:1956-61. doi:10.1016/j.jacc.2012.12.051.
49. Krysiak R, Zmuda W, Okopien B. The effect of simvastatin-ezetimibe combination therapy on adipose tissue hormones and systemic inflammation in patients with isolated hypercholesterolemia. Cardiovascular Therapeutics. 2014;32(2):40-6. doi:10.1111/1755-5922.12057.
50. Ferreira A, Menezes-Garcia Z, Mario E, et al. Increased expression of oxidative enzymes in adipose tissue following PPARα-activation. Metabolism. 2014;63(4):456-60. doi:10.1016/j.metabol.2013.12.009.
51. Takase H, Dohi Y, Okado T, et al. Effects of ezetimibe on visceral fat in the metabolic syndrome: a randomised controlled study. Eur J Clin Invest. 2012;42(12):1287-94. doi:10.1111/eci.12000.
52. Wang Y, Qiao S, Han D, et al. Telmisartan improves insulin resistance: a meta-analysis. Am J Ther. 2018;25(6):642-51. doi:10.1097/MJT.0000000000000733.
53. Barja-Fernandez S, Leis R, Casanueva F, et al. Drug development strategies for the treatment of obesity: how to ensure efficacy, safety, and sustainable weight loss. Drug Design, Development and Therapy. 2014;8:2391-400. doi:10.2147/DDDT.S53129.
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For citations:
Kuznetsova T.Yu., Druzhilov M.A., Chumakova G.A., Veselovskaya N.D. Strategies and methods for the correction of obesity and associated cardiovascular risk. Russian Journal of Cardiology. 2019;(4):61-67. (In Russ.) https://doi.org/10.15829/1560-4071-2019-4-61-67
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