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Medical writings on cardiovascular disease focus on intravascular pressures. Tissue pressure is assumed to be essentially atmospheric. Yet, under dynamic conditions of sitting, standing, walking, breathing, and the beating of the heart, significant pressures, both above and below atmospheric, do develop outside of important arteries. These dynamic extra-arterial pressures either decrease or increase the pressure gradients across arterial walls, i.e. the transmural pressures are changed. Physical fitness may either prevent the development of negative extra-arterial pressure or increase positive extra-arterial pressure, thereby protecting important arteries from high effective pressures. Deconditioning, old age, abdominal obesity, and other cardiovascular disease risk factors may do just the opposite, in effect, causing 'localized hypertension' in clinically important arteries. This, in turn, may lead to localized acceleration of atherosclerosis. The correlation of predictions made from this hypothesis with clinical findings is so remarkable that it suggests there is a direct cause and effect relationship between transmural arterial pressure and atherosclerosis. The concept of dynamic extra-arterial pressure seems to solve a number of puzzles and paradoxes in cardiovascular disease, it suggests key measurements that may be predictive of disease, and it offers new ideas for treatment and prevention.
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PMID:Physical fitness, dynamic extra-arterial pressures, and the pathogenesis and distribution of atherosclerosis. 178 17

The health risks of obesity increase with its severity and reach significance at a weight greater than 20% above optimal, by using life insurance tables, or at a body mass index greater than 27. Risks include hypertension, insulin resistance and diabetes mellitus, cardiovascular disease, hypertriglyceridemia, low high-density-lipoprotein cholesterol, and, in some studies, high total-and low-density-lipoprotein cholesterol. There is an increased mortality from endometrial cancer in women and from colorectal cancer in men. Chronic hypoxia and hypercapnia, sleep apnea, gout, and degenerative joint disease can occur with more severe obesity. The distribution of body fat is directly related to these health risks. Abdominal obesity is more dangerous than gluteal-femoral obesity because the amount of intraabdominal fat seems to determine much of the increased peril; therefore, risks of cardiovascular disease, stroke, hypertension, and diabetes increase with abdominal obesity, even independently of total fat mass.
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PMID:Health implications of obesity. 203 92

Elevated plasma levels of cholesterol and triglycerides, low levels of high-density lipoproteins, hypertension, diabetes mellitus, smoking and abdominal obesity are risk factors for coronary heart disease (CHD) and stroke. Because of the preventable threat to life, well-being and productivity from perturbations of plasma lipoproteins (which affect about 60% of adults), we recommend a population-based strategy with public education on diet, exercise and the hazards of smoking and legislation for better food labelling. This should be combined with the medical guidelines we describe to detect and treat those at highest risk for CHD (including about 15% of adults), who merit priority for the medical, dietetic and laboratory services required. Among people aged 40 years or more this includes those with plasma total cholesterol levels greater than 7 mmol/L, fasting triglyceride levels greater than 3 mmol/L or cholesterol level greater than 6 mmol/L when associated with CHD or other risk factors for CHD. For younger people the criteria for highest risk include cholesterol levels greater than 6.5 mmol/L for those aged 30 to 39 years, greater than 6 mmol/L for those aged 20 to 29 and greater than 5 mmol/L for those under age 20.
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PMID:Guidelines for the detection of high-risk lipoprotein profiles and the treatment of dyslipoproteinemias. Canadian Lipoprotein Conference Ad Hoc Committee on Guidelines for Dyslipoproteinemias. 263 69

Whereas up to the end of the last century overweight reflected the privilege of the high society and her relative good health, the recent epidemiological studies have assessed the relations between body weight and general or cause specific morbidity and mortality. The major diseases associated with obesity are hypertension, atherosclerosis and diabetes, as well as certain types of cancer. Less well known complications include hepatic steatosis, gallbladder diseases, pulmonary function impairment, endocrine abnormalities, obstetric complications, trauma to the weight bearing joints, gout, cutaneous diseases, proteinuria, increased hemoglobin concentration and possibly immunologic impairments. From these wide epidemiological studies arise the definition of obesity: with an excess of 20% beyond the desirable weight, the complications bound to the overweight become statistically more frequent. Over there a U or J shaped curve illustrates the relation between the overweight and the degree of these various complications. An excess of 45 kg or more represents the critical level which defined "morbid obesity" with its own complications, the most important are sudden unexplained death, ventilatory disorders, circulatory congestion and functional limitations in activities of daily living and of course psychological consequences. When for certain complications, such as diabetes, the relationship with the overweight is evident, discrepancies between certain studies, especially for the cardiovascular diseases, had focused the attention on the regional patterns of fat distribution. Cross-sectional studies have shown abdominal obesity to be strongly associated with risk factors for cardiovascular disease, stroke and death independent of the total degree of obesity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The contribution of epidemiology to the definition of obesity and its risk factors]. 266 68

Since there is evidence that fat distribution is a better predictor of cardiovascular disease than the degree of obesity, some risk factors for atherosclerosis have been evaluated in middle age Type II male diabetics and in obese subjects with and without glucose intolerance. In non-insulin-dependent diabetics (NIDD), abdominal obesity reflected by the waist/hip-circumference ratio (WHR) is related to parameters of metabolic control, lipid parameters, insulin status and response, hypertension, and vascular complications. High WHR is associated with: (a) significantly (p less than 0.01) higher HbA1 values than in the group without abdominal fat distribution; (b) a highly significant (p less than 0.001) negative correlation with high-density-lipoprotein cholesterol (HDL-C) and a positive correlation with the total/HDL-C ratio, which remains after correction for the body mass index; (c) higher apolipoprotein B concentrations; and (d) an elevated atherogenic index. Both fasting and postprandial insulin and C-peptide values may be a link between abdominal fat deposits and metabolic disturbances. Obese patients with upper body fat accumulation have significantly lower HDL-C levels, and a higher prevalence of glucose intolerance and diabetes than do patients with lower body fat obesity. Fasting glycemia, insulin, and the insulin area under the curve during an oral glucose load are significantly (p less than 0.005) increased in those with the greatest WHR, which is similar to that in NIDD and central obesity. An excess of abdominally located fat, even without manifest obesity, is associated with metabolic disturbances that indicate increased risk of atherogenesis and of higher morbidity and mortality, which may be due to characteristics of abdominally located adipocytes.
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PMID:Upper body adiposity and the risk for atherosclerosis. 269 50

Due to the recent knowledge that the distribution of fat deposits would be a better predictor of cardiovascular disease than the degree of obesity, some risk factors for atherosclerosis were evaluated in middle age type II male diabetics and in obese subjects with and without glucose intolerance. In non-insulin dependent diabetes, abdominal adiposity reflected by the waist/hip-circumference (WHR) was related to parameters of metabolic control, lipid parameters, blood rheology, insulin status, hypertension and known vascular complications in three different groups. In the groups with abdominal obesity, the mean annual HbA1 is significantly (p less than 0.01) higher than the group without an abdominal fat mass distribution. Atherogenic index is significantly increased in the group with the highest WHR. HDL-cholesterol levels are significantly decreased in both groups with upper body fat distribution. A highly significant (p less than 0.001) correlation was present between WHR and HDL-cholesterol and WHR and total/HDL-cholesterol ratio; this significant correlation remains after correction for body mass index. Whole blood and plasma viscosity and fibrinogen levels are significantly (p less than 0.05) increased in diabetics with upper body fat accumulation and could be compared to patients with proven coronary ischemic heart disease. The frequency of peripheral vascular disease, coronary ischemic heart disease and hypertension is most prominent in diabetics with an abdominal fat mass distribution. Systolic blood pressure even seems to be increased in non-obese diabetics with the highest WHR. A correlation could be found between WHR and both systolic and diastolic blood pressure. When corrected for body mass index the same significant correlation between WHR and blood pressure remained. Both fasting and postprandial insulin and C-peptide values may be the link between abdominal fat deposits and all metabolic disturbances. These results confirm the negative effect of an excess of abdominally located fat cells, even without manifest obesity, on diabetes metabolic control, lipid fractions, hypertension, insulin behaviour, blood rheology and cardiovascular complications. In obese patients with upper body fat accumulation a higher prevalence of glucose intolerance and diabetes is present, in contrast to their counterparts with lower body fat deposit. Both fasting glycemia, insulin and insulin area are significantly (p less than 0.005) increased in the group with the greatest WHR.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Body fat mass distribution. Influence on metabolic and atherosclerotic parameters in non-insulin dependent diabetics and obese subjects with and without impaired glucose tolerance. Influence of weight reduction. 280 Jun 85

Because recent knowledge indicates that the distribution of fat deposits in men may be a better predictor of cardiovascular disease than the degree of obesity alone, some risk factors for atherosclerosis were evaluated in 51 middle-aged men with non-insulin-dependent diabetes mellitus. Abdominal adiposity (waist/hip ratio, WHR) was related to parameters of metabolic control, lipid parameters, and known vascular complications in three different groups. In groups with abdominal obesity, mean annual hemoglobin A1 was significantly (P less than .01) higher than in patients without an abdominal fat distribution. Atherogenic index was significantly increased in the group with the highest WHR and high-density lipoprotein cholesterol (HDL-chol) levels were significantly decreased in both groups with upper-body fat distribution. The frequency of peripheral vascular disease, coronary ischemic heart disease, and hypertension was most prominent in diabetic subjects with an abdominal fat mass distribution. A highly significant (P less than .001) correlation was present between WHR and HDL-chol and WHR and the total-cholesterol/HDL-chol ratio; this significant correlation remains after correction for body mass index. A similar correlation could be found between WHR and systolic and diastolic blood pressures. These results demonstrate an association of excess abdominal fat, even without manifest obesity, with worse diabetes metabolic control, cardiovascular complications, and blood lipid levels actually considered to play an important role in atherogenesis.
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PMID:Relationship of body fat distribution pattern to atherogenic risk factors in NIDDM. Preliminary results. 338 30

There is growing evidence that differences in fat distribution can be predictive for differences in the prevalence of metabolic disturbances, cardio-vascular disease, stroke and death, independent of commonly used indices of obesity. This study evaluates regional body fat distribution as a possible main reason for hypertension in obese and non-obese type II diabetics. 42% of normal weight diabetics with abdominal obesity are hypertensive versus 47% of obese diabetics; only 5% hypertension could be found when a lower body segment fat distribution is present. A significant (p less than 0.001) correlation exists between fat mass topography and both systolic (r = 0.49) and diastolic (r = 0.49) blood pressure. This correlation remains true after correction for body mass index and percent glycosylated hemoglobin. These results suggest that localization of fat in the upper body segment should be considered as a additive risk for hypertension.
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PMID:Hypertension in obese and non-obese non-insulin dependent diabetics a matter of regional adiposity? 341 Jan 53

In over 30 years of surveillance of 2873 women, 574 developed initial clinical manifestations of CHD. A number of antecedent metabolic risk factors proved atherogenic, including blood lipids, glucose tolerance, uric acid, and menopause. Serum total cholesterol predicts as strongly in women as in men. The predictive power of cholesterol is strengthened when the total cholesterol is partitioned into its atherogenic LDL and protective HDL fractions. Contrary to the case in men, triglyceride may be a contributor to risk in older women. A total-to-HDL cholesterol ratio exceeding 7.5 equalizes the risk in men and women. Impaired glucose tolerance also eliminates the female CHD risk advantage over men, conferring a three-fold increased risk. Serum uric acid, although lower in women than in men, is equally predictive in the sexes. Central obesity confers an increased CHD risk in women and predisposes to diabetes, hyperuricemia, hypertension, and an unfavorable LDL/HDL cholesterol ratio. A combination of obesity, low HDL cholesterol, and impaired glucose tolerance predisposes especially. Age-adjusted risk of CHD is increased two- to threefold compared to pre menopausal women, even when induced surgically without removing the ovaries. It is not clear whether post menopausal estrogen replacement eliminates this excess risk. Fibrinogen is higher in women than in men, and is increased with hypertension, diabetes, hypercholesterolemia, high hematocrit, and cigarette smoking. At any level of multivariate risk, fibrinogen added to the CHD risk in women.
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PMID:Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study. 360

Obesity is a heterogeneous group of disorders in terms of etiology; time of development; adipose tissue characteristics; metabolic abnormalities; and associated morbidity and mortality from coronary disease. The typical patient at risk for coronary artery disease in middle age develops abdominal obesity with hypertrophic fat cells in young adulthood, has hypertension, hyperglycemia, hypertriglyceridemia, hypercholesterolemia, and decreased high density lipoprotein (HDL)-cholesterol levels. Two common genetic metabolic disorders--noninsulin-dependent diabetes and familial combined hyperlipidemia--both conform to the prototype, accounting perhaps for a substantial amount of the coronary artery disease associated with obesity.
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PMID:Obesity and common genetic metabolic disorders. 406 24


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