Early markers of cardiovascular damage in obese subjects

Cardiovascular disease remains a frequent cause of morbidity and mortality in industralized countries, particularly in subjects with hypertension, dia betes mellitus, and dyslipidemia, conditions frequently associated with cen tral obesity. Identification of early morphological and/or functional alter ations of the cardiovascular system may help target individuals most likely to benefit from preventive measures. The literature data and our own exper ience suggest that parameters that are direct expressions of cardiovascular damage, can be identified at an early stage. For example, diastolic dysfun ction may precede the clinical expression of several cardiac diseases, left ventricular hypertrophy is one of the first manifestations of cardiac invo lvement in hypertension, central obesity and diabetes mellitus, and a carot id plaque may point to concomitant coronary artery disease. Other early man ifestations of cardiovascular involvement are microalbuminuria and endothel ial dysfunction. Insulin resistance and alterations of the renin-angiotensi n-aldosterone system play an important physiopathogenic role in the develop ment of cardiovascular damage in obese subjects, and their association with risk and cardiovascular disease has been confirmed in numerous studies. Si nce all these changes generally precede overt clinical manifestations and a re closely related to cardiovascular morbidity, they may help identify indi viduals at the highest risk of cardiovascular events. (C) 1999, Medikal Pre ss.