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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coronary heart disease (CHD) is the leading cause of mortality in the United States. Hypertension, diabetes mellitus, hypercholesterolemia, and smoking have all been directly related to CHD. Obesity is on the rise in the United States and has also been associated with CHD. This review clearly establishes obesity as an independent risk factor for CHD as demonstrated by the Framingham Heart Study, Nurses Health Study, Buffalo Health Study, and the Cancer Prevention Study II. Morbid obesity was found to correlate with a significant risk of mortality from CHD, especially in young men. Prevention of obesity, and therefore reduction in risk from cardiovascular disease, is paramount in the management of obesity. New approaches to behavioral, medical, and surgical management of obesity are reviewed, including thalidomide, an antiangiogenic agent. A primary and secondary prevention model details a multidisciplinary approach to reducing risk in obesity.
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PMID:Obesity and the risk for cardiovascular disease. 1262 62

Obesity is known to predispose to obstructive sleep apnea (OSA), a condition characterized by repeated episodes of apnea or hypopnea during sleep, due to the interruption of airflow through the nose and mouth. These episodes lead to the fragmentation of sleep and to decrease in oxyhaemoglobin saturation. Patients with massive obesity, with or without daytime hypersomnolence should be systematically screened for OSA, because many of them appear to be asymptomatic and unaware of their breathing abnormalities during sleep. Polysomnography (PSG) in an attended hospital laboratory setting is the gold standard for the diagnosis of OSA. However portable recording devices can be used for screening with good sensibility and specificity, and even for diagnosis when the apnea-hypopnea index is high. However the final diagnosis can only be carried out in a sleep laboratory using PSG by highly-qualified personnel, because of the limitations of the portable recording device. There is a strong association between OSA and the risk of traffic accidents. It has been established that OSA affects quality of life. There is also increasing evidence that OSA is an independent risk factor for cardio-vascular diseases. This has been successfully demonstrated for hypertension by prospective studies. But the evidence remains weak for myocardial infarction, stroke or mortality. Treating OSA with continuous positive airway pressure (CPAP) is the treatment of choice. CPAP improves quality of life, driving simulator performance, blood pressure and sleepiness, as demonstrated by randomised placebo controlled trials. The majority of obese OSA patients are currently not being offered diagnosis testing and treatment. It's a real challenge due to the epidemic increase of obesity prevalence. Portable recording devices could be available outside the sleep laboratory in nutrition department, where morbid obesity is treated. This emphasizes the need for a real collaboration between these departments and sleep experts.
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PMID:[How do you really know if the obese patient has sleep apnea?]. 1273 28

Besides genetic predisposition, obesity is the most important risk factor for the development of diabetes mellitus. Weight reduction has been shown to markedly improve blood glucose control and vascular risk factors associated with insulin resistance in obese individuals with type 2 diabetes. Therapeutic strategies for the obese diabetic patient include: (i) promoting weight loss, through lifestyle modifications (low-calorie diet and exercise) and antiobesity drugs (orlistat, sibutramine, etc.); (ii) improving blood glucose control, through agents decreasing insulin resistance (metformin or thiazolidinediones, e.g. pioglitazone and rosiglitazone) or insulin needs (alpha-glucosidase inhibitors, e.g. acarbose) in preference to agents stimulating defective insulin secretion (sulphonylureas, meglitinide analogues); and (iii) treating common associated risk factors, such as arterial hypertension and dyslipidaemias, to improve cardiovascular prognosis. Whenever insulin is required by the obese diabetic patient after failure to respond to oral drugs, it should be preferably prescribed in combination with an oral agent, more particularly metformin or acarbose, or possibly a thiazolidinedione. When morbid obesity is present, both restoring a good glycaemic control and correcting associated risk factors can only be obtained through a marked and sustained weight loss. This objective justifies more aggressive weight reduction programmes, including very-low-calorie diets and bariatric surgery, but only within a multidisciplinary approach and long-term strategy.
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PMID:Current management strategies for coexisting diabetes mellitus and obesity. 1279 Jun 91

Obesity, which was evaluated positively in our culture in past periods and which was even considered by some to be merely an aesthetic question, is a disease with serious consequences for the health of the person suffering from it, and for the economy of those who have to meet its costs. Its present prevalence in Spain is situated around 13% and, if we can trust the forecasts established for other western countries such as the USA, it will increase to become the epidemic of the present century. The consequences of excess weight on the cardiovascular, respiratory, digestive, osteoarticular, reproductive and endocrine-metabolic systems are well known, as well as the relation between obesity and some types of cancer. As a general rule, it is worth bearing in mind that the greatest complications will correspond to the greater overweight (morbid obesity and severe obesity) and that age, the duration of ponderal excess and the distribution of the additional fat also have an influence, given that android/visceral/abdominal obesity is accompanied by the so-called insulin resistance syndrome. It is thus usually accompanied by hypertension, dyslipemia, alterations of hydrocarbonate tolerance and coagulation, elements involved as a whole in cardio-vascular morbi-mortality.
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PMID:[Complications of obesity]. 1286 Dec 76

Anesthesia during and after off-pump surgery is critical for the outcome of the procedure. Intubation time has been shown to correlate with ICU time and length of stay. This study is to evaluate the extubation time and predictors of prolonged extubation in this institution. One hundred and sixty consecutive patients during Jan 2001-June 2002, excluding pre-operative tracheostomy (n = 1) were retrospectively reviewed. Anesthetic agents include fentanyl, rocuronium Bromide, midazolam and sevoflurane. Phenylephrine and nitroglycerine were used to maintain adequate arterial pressures. Post-operative pain control was mainly with intravenous fentanyl and oral pain medications. The extubation time was divided into 4 groups; 0-2 h, n = 76, mean = 1.11 +/- 0.5 h; 2-4 h, n = 30, mean = 2.91 +/- 0.5 h; 4-24 h, n = 39, mean = 11.44 +/- 7.3 h; > 24 h, n = 5, mean = 33.3 +/- 21 h. The data were collected and analyzed following the guidelines of National STS cardiac surgery database. All pre-operative risk factors included: Age (> 70 yrs vs < or = 70 yrs), gender (male vs female), diabetes (yes vs no), hypertension (yes vs no), morbid obesity (yes vs no), renal insufficiency (yes vs no), chronic obstructive lung disease (yes vs no), history of cerebrovascular accident (yes vs no), smoking (yes vs no), dyslipidemia (yes vs no), history of myocardial infarction (MI) (yes vs no), history of congestive heart failure (CHF) (yes vs no), unstable angina (yes vs no), left ventricular ejection fraction (LVEF) (> 40% vs < or = 40%), left main (LM) lesion (LM > 50% vs LM < or = 50%), intra-aortic balloon pump (IABP) used (yes vs no) and time between operating and closing (> 4.30 h vs < or = 4.30 h) were used to predict failed early extubation (2 h). More than 50 per cent of the patients were extubated in less than 2 h (1.11 +/- 0.5 h) and only 5 patients were extubated after 24 h. Univariate analysis revealed old age, diabetes, MI, CHF, LVEF < or = 0.4 and the use of IABP are the predictors (p < 0.05) of failed early extubation. Multivariate analysis of these variables revealed old age with adjusted odds ratio of 4.6 (95% CI = 1.5-13.7) p < 0.01, diabetes with adjusted odds ratio of 3.2 (95% CI = 1.3-7.5) p < 0.01 and IABP used with adjusted odds ratio of 4.3 (95% CI = 1.3-14.6) p = 0.02 are the predictors of fail early extubation. The findings suggested early extubation is possible in OPCAB surgery and attention should be made when operate in patients who have old age, diabetes, and IABP used.
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PMID:Off-pump coronary artery bypass surgery: evaluation of extubation time and predictors of failed early extubation. 1286 66

In most industrialized countries, 40-60% of the population is now overweight or obese. Obesity has recently been recognized as a major modifiable risk factor for cardiovascular disease, second only to cigarette smoking. Excess weight and obesity markedly increase the risk for hypertension, diabetes, coronary artery disease and congestive heart failure in both men and women. Populations most severely affected include the poor, the uneducated and certain racial and ethnic groups. Obesity is currently classified based on body mass index (BMI), but measurement of waist circumference as an important determinant of cardiovascular and metabolic risk is receiving increasing acceptance. For moderate overweight and obesity, interventions include dietary modification, increasing physical activity, behavior therapy and pharmacotherapy. Surgery is currently the only viable approach to morbid obesity.
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PMID:Obesity and cardiovascular risk. 1291 19

The subject is a diabetic and hypertensive woman treated early during an unplanned pregnancy with a multi-drug regimen that included three drugs with no prior history for use in pregnant women (rosiglitazone, gliclazide, atorvastatin). She was under care for chronic hypertension, which she suffered for 14 years, and diabetes mellitus, hypercholesterolemia, anxiety disorder, morbid obesity and epilepsia for 5 years. She was exposed to rosiglitazone (4mg/day), gliclazide (60mg/day), and atorvastatin (40mg/day) in addition to acarbose, spironolactone, hydrochlorothiazide, carbamazepine, thioridazine, amitryptiline, chlordiazepoxide, and pipenzolate bromide during the first 7 weeks of gestation while unaware of pregnancy. Pharmacotherapy was adjusted following clinical recognition of pregnancy during the 8th week. She gave birth to a normal healthy infant at the 36th week of gestation. This is the first reported case of human exposure to rosiglitazone, gliclazide, and atorvastatin during pregnancy. Although the normal pregnancy outcome does not address the safety of these drugs for use in pregnancy, these data contribute to a limited knowledge regarding human exposure to these antidiabetic drugs.
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PMID:Normal pregnancy outcome following inadvertent exposure to rosiglitazone, gliclazide, and atorvastatin in a diabetic and hypertensive woman. 1513 57

This study analyzes the relationship between risk factors related to overweight/obesity, insulin resistance, lipid tolerance, hypertension, endothelial function and genetic polymorphisms associated with: i) appetite regulation (leptin, melanocortin-3-receptor (MCR-3), dopamine receptor 2 (D2R)); ii) adipocyte differentiation and insulin sensitivity (peroxisome proliferator-activated receptor-gamma2 (PPAR-gamma2), tumor necrosis factor-alpha (TNF-alpha)); iii) thermogenesis and free fatty acid (FFA) transport/catabolism (uncoupling protein-1 (UCP1), lipoprotein lipase (LPL), beta2- and beta3-adrenergic receptor (beta2AR, beta3AR), fatty acid transport protein-1 (FATP-1) and iv) lipoproteins (apoliprotein E (apoE), apo CIII). The 122 members of 40 obese Caucasian families from southern Poland participated in the study. The genotypes were analyzed by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) or by direct sequencing. Phenotypes related to obesity (body mass index (BMI), fat/lean body mass composition, waist-to-hip ratio (WHR)), fasting lipids, glucose, leptin and insulin, as well as insulin during oral glucose tolerance test (OGTT) (4 points within 2 hours) and during oral lipid tolerance test (OLTT) (5 points within 8 hours) were assessed. The insulin sensitivity indexes: homeostasis model assessment of insulin resistance, whole body insulin sensitivity index, hepatic insulin sensitivity and early secretory response to an oral glucose load (HOMA-IR, ISI-COMP, ISI-HOMA and DELTA) were calculated. The single gene mutations such as C105 T OB and Pro115 Gln PPAR-gamma2 linked to morbid obesity were not detected in our group. A weak correlation between obesity and certain gene polymorphisms was observed. Being overweight (25 < BMI > or = 30 kg/m2) significantly correlated with worse FFA tolerance in male PPAR-gamma2 12Pro, LPL-H (G) allele carriers. Insulin resistance was found in female PPAR-gamma2 Pro12, TNF-alpha (-308A) and LPL-H (G) allele carriers. Hypertension linked to the PPAR-gamma2 Pro allele carriers was characterized by high leptin output during OLTT. We conclude that the polymorphisms we investigated were weakly correlated with obesity but significantly modified the risk factors of the metabolic syndrome.
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PMID:Analysis of candidate genes in Polish families with obesity. 1520 83

The obstructive sleep apnoea syndrome (OSAS) is caused by upper airway collapse during sleep. These episodes are associated with recurrent oxyhaemoglobin desaturations and arousals which lead to disruption of the sleep pattern and cognitive deterioration. Factors such as age, male sex, menopause, tobacco and alcohol consumption and anatomic abnormalities are demonstrated risk factors for OSAS development. Obesity, specially of abdominal type, is also a very strong predictor of OSAS, increasing the risk of apnoea by ten times. OSAS prevalence may reach 80% and 50% en males and females with morbid obesity respectively. OSAS induces sympathoexcitation, insulin resistance, renin-angiotensin system activation, oxidative stress, endothelial dysfunction, hypercoagulability and reduction of fibrinolysis leading to hypertension and increased cardiovascular risk. The best diagnostic procedure is polysomnography. Obesity treatment is followed by a dramatic improvement in OSAS. Weight loss of 10% results in reductions of apnoea index by 26%. Application of a positive pressure system is a very effective treatment for OSAS which reduces the apnoea index and improves cardiovascular risk and cognitive impairment.
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PMID:[The obstructive sleep apnoea syndrome in obesity: a conspirator in the shadow]. 1538 14

Obesity is an important health problem for the growing elderly segment of the population. Age-related changes in body composition should be taken into account when considering morbidity. Today, sarcopenic obesity, which is defined as excess fat with loss of lean body mass, is a highly prevalent problem. Obesity in the elderly is related to morbidity; e.g., sleep apnea, cancer, osteoarthritis, diabetes and hypertension. The advantages and disadvantages of using BMI, waist circumference, waist: hip ratio, and body weight to measure age-related changes in obesity are discussed. In addition, the merits of treatment options for obesity; e.g., behavioral modifications, diet, and exercise--are described. One important conclusion derived from a review of these treatments is that age itself is not a contraindication for pharmacotherapy or even surgery for morbid obesity.
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PMID:Obesity in the elderly: survival of the fit or fat. 1555 40


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