AHA Updates Guidance on Obesity and Cardiovascular Risks

The AHA has updated recommendations on obesity and its relationship with heart disease. The document was published in the journal Circulation.

Main provisions of the document:

  • Abdominal obesity, even with a normal body mass index (BMI), can provoke cardiovascular diseases (CVD).
  • Patients who are obese (based on BMI) do not always have abdominal obesity.
  • Abdominal obesity is a risk factor for the development of CVD and may increase the risk of mortality in patients.
  • Having metabolically healthy obesity may be temporary.
  • People with excess visceral fat may be at high risk of CVD, regardless of BMI.

Lifestyle changes and subsequent weight loss improve metabolic syndrome well-being and reduce systemic inflammation. However, as the scientists noted, weight loss using pharmacotherapy did not lead to a reduction in the incidence of coronary heart disease.

Bariatric surgery

Prospective studies conducted in Sweden showed a reduction in the risk of CAD and fatal outcomes in patients undergoing surgery. The latest data presented in the paper describes the potential of bariatric surgery to reduce the incidence of adverse cardiac events: from 47.7 to 30.8% among patients in the study.

Drug therapy

The document notes existing drugs on the market for the treatment of obesity, in particular, orlistat, a lipase inhibitor, which has proven but rather limited effectiveness and safety. Also used for the treatment of obesity is liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, which was initially registered for the treatment of type 2 diabetes mellitus (T2DM), and then for the treatment of obesity (including without disorders of carbohydrate metabolism). Trials of these drugs are ongoing.

For the first time in international leadership, the AHA has paid close attention to the control of excess weight as one of the important factors in the development of atrial fibrillation (AF). Scientists suggest using weight control as one of the approaches to treating AF along with anticoagulants.

The influence of lifestyle and weight loss on the course of coronary heart disease and heart failure was also noted in the document.

The authors note: Obesity is a global epidemic. Over the past 40 years, there has been an increase in the number of patients in most countries of the world. According to NHANES data from 2015–2018, the prevalence of obesity among US adults over the age of 20 years was 39.9% for men and 41.1% for women.

“One of the important goals of the guidance is to convey the message that obesity is a complex and multifactorial disease. People suffer from obesity not only due to biological reasons, but also due to environmental, psychosocial and other factors. We want cardiologists to not overlook abdominal obesity,” said Dr. Tiffany Powell-Wylie (Tiffany Powell-Wiley).

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