Cardiovascular imaging for the assessment of obesity-related cardiovascular disease
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Corresponding author Amgad N. Makaryus, MD Department of Cardiology, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2009, 3:89–94 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2009 by Current Medicine Group LLC
Obesity has reached epidemic proportions throughout the world and is associated with numerous cardiac comorbidities, such as hypertension, type 2 diabetes mellitus, and hyperlipidemia. Through its direct effects on cardiac structure and function and its impact on conventional risk factors, obesity is strongly associated with cardiovascular diseases such as heart failure and coronary heart disease (CHD). Cardiovascular imaging is applied in daily clinical practice for the diagnostic assessment of patients with suspected CHD. Imaging allows the clinician to noninvasively assess and risk-stratify patients to allow for the proper management of CHD. Imaging modalities such as radionuclide cardiac stress imaging, echocardiography and, increasingly, cardiac computed tomography and cardiac magnetic resonance play an important role in the diagnosis of CHD in patients with obesity. Due to the increasingly prevalent nature of obesity and its strong association with cardiovascular disease, CHD remains the leading cause of mortality for adult patients with obesity.
Introduction Obesity is a well-established risk factor for coronary heart disease (CHD), which is the leading cause of mortality of men and women in the Western world [1••,2]. Obesity predisposes a person to a number of other cardiovascular risk factors and is an independent predictor of clinical cardiovascular disease, including death from myocardial infarction, CHD, heart failure, and stroke. Among adults, obesity was associated with nearly 112,000 excess deaths (95% CI, 53,754–170,064) relative to normal weight in 2000 [1••]. Both the distribution of body fat, which varies
among individuals, and the amount of body fat are important in determining CHD risk. Excess accumulation of fat around the upper body has been associated with a higher risk of CHD regardless of total body fat [3]. Furthermore, inflammation due to fat depots and myocardial metabolism abnormalities may contribute to the development of obesity-related heart failure [4]. The prevalence of obesity remains a major concern in the United States. More than 9 million children and adolescents from 6 to 19 years of age are considered overweight on the basis of being in the 95th percentile or higher of body mass index values in the 2000 Centers for Disease Control and Prevention growth chart. Further, on the basis of data from the National Health and Nutrition Examination Survey, in 2003–2004, 36% of women 65 to 74 years of age and 24% of women 75 years of age were obese. This is an increase from 1988–1994, when 27% of women 65 to 74 years of age and 19% of women 75 years of age and older were obese. For men, in 1988–1994, 24% of those 65 to 74 years of age and 13% of those 75 years of age and old
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