Obesity and cardio-vascular risk

Overweight and obesity are recognised as responsible for an increase in vas cular risk and in excess mortality due to cardiovascular diseases, This is especially true in presence of increased visceral (central) fat distributio n, a key factor for insulin-resistance, the main component of the metabolic syndrome X. Cardio-vascular risk in overweight and obese subjects appears strongly correlated with the common risk factors, more frequently present i n these patients: type 2 diabetes, hypertension, lipid abnormalities. Weigh t reduction improves all risk factors and decreases the patient's global va scular risk. The improvement in the various risk factors is significant wit h a moderate weight loss (10% of the initial weight). Weight reduction should been obtained always with nutritional-hygienic mean s (physical activity, weight-reducing diet...) maintained for several month s. Only when these approaches appear to be insufficient, the need for an as sociated pharmacological treatment has to be considered. Amongst the weight -reducing drugs currently available or close to be, orlistat has demonstrat ed its interest in the glycemic control of type 2 diabetic patients, and it s favourable effect in hypertensive patients. Available clinical studies ha ve clearly shown the more marked effect of orlistat in comparison to placeb o in reducing the various risk factors. So far, few studies have been conducted to assess the effects of the specif ic drug therapy on the control of metabolic abnormalities and risk factors in overweight or obese patients, except in type 2 diabetic patients for who m, most of the oral anti-diabetic agents have been tested in overweight or obese diabetic population.