The European Society of Cardiology (ESC) has released a Clinical Consensus Statement on Obesity and Cardiovascular Disease, presented at the ESC Congress in London, UK, from August 30 to September 2, 2024.
This statement provides a comprehensive overview of the current understanding of obesity, its connection to cardiovascular disease (CVD), and effective management strategies.
Published in both the European Heart Journal and the European Journal of Preventive Cardiology, the statement addresses the growing global challenge of obesity and its significant impact on cardiovascular health.
Obesity has become a critical public health issue, with its prevalence more than doubling over the past four decades.
Today, over a billion people worldwide are affected by obesity, which is now recognized not only as a major risk factor for various chronic illnesses but as a disease in its own right.
The condition is associated with a reduced quality of life and shortened life expectancy. Importantly, 67.5% of deaths linked to high body mass index (BMI) are due to cardiovascular disease, underscoring the urgent need for effective management.
The Consensus Statement, co-authored by experts including Professor Emeline Van Craenenbroeck from Antwerp University Hospital, Belgium, and Professor Eva Prescott from the University of Copenhagen, Denmark, aims to raise awareness about obesity as a significant cardiovascular risk factor.
It also offers practical guidance on preventing and managing obesity within the context of both primary and secondary CVD prevention.
Obesity not only contributes to well-known cardiovascular risk factors like type 2 diabetes (T2DM), dyslipidemia, and hypertension, but it also directly impacts cardiac structure and function.
This can lead to various forms of CVD, including atherosclerotic disease, heart failure, arrhythmias, and sudden cardiac death, independent of other risk factors.
The Consensus Statement emphasizes that while genetics and biological factors play a role in the development of obesity, the global obesity epidemic is primarily driven by environmental and societal factors.
The statement also highlights that individuals with similar BMI levels may have different cardiometabolic risks, suggesting that additional measures of abdominal adiposity, such as waist circumference and waist-to-hip ratio, can provide more precise risk assessments.
A key focus of the statement is the strong connection between obesity and type 2 diabetes. About 80-85% of people with T2DM are overweight or obese, and those with obesity are nearly three times more likely to develop T2DM compared to individuals of normal weight.
Effective weight loss interventions can significantly improve glycemic control in patients with T2DM, even leading to remission in some cases. Furthermore, high BMI is responsible for a large proportion of hypertension cases, particularly in younger adults.
The relationship between obesity and various cardiovascular conditions, including atrial fibrillation, heart failure, and valvular disease, is thoroughly discussed in the Consensus Statement.
It underscores that obesity is both preventable and treatable, advocating for a multidisciplinary approach that includes behavioral interventions, nutrition, physical activity, pharmacological therapy, and in some cases, bariatric surgery.
Despite the availability of various treatment options, obesity management has often been overlooked compared to other modifiable cardiovascular risk factors.
However, the introduction of newer anti-obesity medications has sparked renewed interest in treating obesity as a therapeutic target.
Professor Konstantinos Koskinas from Bern University, Switzerland, highlights that these medications offer significant weight loss and have proven benefits for cardiovascular outcomes, making them a valuable addition to obesity management strategies.
The statement provides detailed guidance on non-pharmacological and pharmacological treatments for obesity. Dietary interventions typically aim for a daily energy deficit of 500-750 kcal, with adjustments based on individual needs.
While weight loss in the range of 5-10% can be achieved through nutritional and multidisciplinary approaches, maintaining this weight loss remains a challenge.
Physical activity, although modest in its impact on weight loss, is crucial for maintaining weight loss and reducing overall cardiovascular risk.
Regarding pharmacological treatments, the statement advises caution when using certain weight-loss medications, such as orlistat and bupropion/naltrexone, particularly in patients with existing cardiovascular disease.
These medications have modest effects on weight and limited evidence regarding their long-term cardiovascular safety.
In contrast, glucagon-like peptide-1 (GLP-1) agonists, such as semaglutide, have shown effectiveness in both weight loss and improving cardiovascular risk factors.
The authors of the Consensus Statement emphasize that while individual treatment of obesity is important, the broader issue requires public health interventions to address the environmental and societal factors driving the obesity epidemic.
They call for proactive efforts from healthcare providers, including cardiologists, to prevent and manage obesity alongside other cardiovascular risk factors.
The statement concludes that lifestyle interventions should remain the first line of treatment for obesity, with pharmacological options serving as complementary rather than substitutive measures.
Long-term adherence to a healthy lifestyle is critical to maintaining the benefits of both lifestyle and drug interventions.
Overall, the ESC Clinical Consensus Statement provides a robust framework for addressing the growing challenge of obesity and its impact on cardiovascular health, advocating for a comprehensive, multidisciplinary approach to treatment and prevention.
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The research findings can be found in the European Journal of Preventive Cardiology.
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