Obesity has become an epidemic disease, mainly caused by unhealthy lifestyle and genetic predisposition. Obesity is an independent risk factor for cardiovascular disease and is closely related to cardiovascular death. Recently, at the ESC 2022 conference, Professor Shady Abohahem of Harvard Medical School shared the results of a study on obesity and cardiovascular mortality, and this issue invited him to conduct an in-depth discussion.
International Circulation: At this conference, you announced a study on obesity and cardiovascular disease. What are the main results?
Professor Shady Abohahem: That’s a good question. In this study, we basically evaluated the impact of obesity prevalence at the community level in the United States, looking at the cardiovascular mortality burden. We observed there was a significant increase in the prevalence of obesity among adults in the United States from 2010 to 2019. This increase is also reflected in the curve for cardiovascular mortality rates. We noticed that people in the poorer counties or regions with a higher prevalence of obesity tend to have higher cardiovascular mortality rates at the baseline in 2010 versus the counties that have the lowest obesity rates. This observation was more interesting because this large gap between the upper and lower persisted over all years through to 2019. Further, we wanted to evaluate the nutritional factors contributing to obesity at the community level. We started with a univariate model, and then a multivariate model. We had to adjust for so many confounders so that we could potentially have a plausible association with cardiovascular mortality, namely, we adjusted for demographics, adjustable cardiovascular risk factors, adjustable socio-economic factors, lifestyle (access to exercise facilities), environmental risk factors (like air pollution, water quality), and healthcare access. These factors are mainly driving the spread of cardiovascular mortality across the country. What we observed after this multivariate adjustment is that there is an increased rate of cardiovascular mortality attributed to obesity prevalence of around 1.015%. This translates to around 4 AYD per 100,000 individuals.
International Circulation: What are the cardiovascular risk factors in obese patients? How to intervene?
Professor Shady Abohahem: The conventional risk factors that we know for cardiovascular disease, like age, sex, hypertension, hyperlipidemia, smoking and diabetes are well-established, and we know they also contribute to obesity. There is the reverse association between obesity and those risk factors. Obesity is known to cause hypertension and hypercholesterolemia and in turn inflammation and plaque formation, which then increase cardiovascular disease risk. This strengthens the link between obesity and cardiovascular diseases. But there are other risk factors that we don’t really pay attention to. They might not be established or conventional risk factors for cardiovascular disease, but they are really well-established risk factors for obesity, such as lifestyle. People who are less physically active and more sedate lifestyle tend to be obese. People who have less access to exercise facilities tend to be obese. People who are eating more processed food and with limited healthy choices. Of course, there are genetic factors. There are societal factors.
International Circulation: What are the differences in the incidence of cardiovascular disease in different obese people?
Professor Shady Abohahem: That was one of the main objectives of our study - to look at the disparities in the cardiovascular mortality rates associated with obesity. Disparities between obese people has already been well-established. We know women have a tendency to be more obese. We know Hispanics and Blacks have a higher obesity prevalence compared to White. We know that middle aged people are more obese than the elderly. When we look at the curves for obesity we see that it is reflected in the curve for cardiovascular mortality for each of these demographics. What we observed in our study after multivariate adjustment is that there are high rates of cardiovascular mortality attributed to obesity in female Hispanics, in middle-aged females, in middle-aged Whites and Hispanics overall. These disparities are not really surprising because we know that females, for example, show high ethnic disparities in relation to maternal health outcomes and we know that cardiovascular disease is a leading cause of death in this population. We also know that with Hispanics and Blacks, cultural and racial biases have a disproportionate impact on socio-economic and environmental risk factors. Populations in counties or regions that have a higher prevalence of obesity tend to have limited or low levels of physical activity, few facilities that allow for physical activity or exercise, and limited access to health services. These are some of the major determining factors for high rates of cardiovascular mortality within marginalized populations.
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