Obesity and cardiovascular disease - Pathogenetic role of the metabolic syndrome and therapeutic implications

Since obesity is a major risk factor for cardiovascular disease (CVD), the increasing prevalence and degree of obesity in all developed countries has the potential to significantly offset the current efforts to decrease CVD b urden in our population. Obesity is pathogenetically related to several cli nical and sub-clinical abnormalities that contribute to the development of atherosclerotic placks and their complication, leading to the onset of card iovascular events. Obesity seems to interact with inheritable factors in de termining the onset of insulin resistance, a metabolic abnormality that is responsible for altered glucose metabolism and predisposition to type 2 dia betes, but that also has a major role in the development of dyslipidemia, h ypertension and many other sub-clinical abnormalities that contribute to th e atherosclerotic process and onset of cardiovascular events. Inheritable f actors seem to modulate the onset of type 2 diabetes, dyslipidemia, hyperte nsion and various insulin resistance-related sub-clinical abnormalities, of ten in a clustering pattern that is commonly referred to as the "metabolic syndrome." Inheritable factors also are involved in the onset of CVD in a g iven population or individuals with various components of the metabolic syn drome. Intense research is currently undergoing to better understand the mo lecular mechanisms that could explain the relationship between environmenta l and inheritable factors that lead from obesity to atherosclerosis and car diovascular event. The elucidation of these mechanisms will provide improve d therapeutic strategies to reduce cardiovascular risk in the obese patient s. However, effective therapeutic teals that control each of the known path ophysiological steps mediating CVD in obese patients are already available and should be used mon aggressively Patient education and coordinated appro ach of physicians, nurses and other health care providers in a multidiscipl inary treatment of the obese patient is of fundamental importance to reduce CVD burden in our population. (C) 2000 Elsevier Science Inc. All rights re served.