The athero-thrombotic and inflammatory profile of visceral obesity

摘要

The prevalence of type 2 diabetes has substantially increased in North America largely due to the fact that obesity has reached epidemic proportions in our society. Although obesity increases the likelihood of developing type 2 diabetes, hypertension and coronary heart disease (CHD), not every obese patient is characterized by these complications, emphasizing the fact mat obesity is a heterogeneous condition. Evidence reviewed in this short paper supports the notion that body fat distribution, especially visceral adipose tissue accumulation, is a critical correlate of a cluster of diabetogenic, atherogenic, thrombotic and inflammatory metabolic abnormalities. This "dysmetabolic cluster", referred to as the insulin resistance or metabolic syndrome, is associated with a substantially increased risk of CHD, even in the absence of hyperglycemia or elevated LDL cholesterol concentrations. From a risk assessment standpoint, we have reported that the "hypertriglyceridemic waist" phenotype (waist circumference > 90 cm combined with triglycerides > 2.0 mmol/1) was associated with ahigh likelihood (80%) of finding the cluster of metabolic abnormalities of abdominal obesity. Since waist circumference has been suggested to be a useful index of abdominal visceral obesity and of related metabolic complications, it is suggested that waist girth should be systematically measured in a!I patients. Finally, it is proposed that until abdominal obesity is identified as a therapeutic target, clinicians will not optimally manage cardiovascular disease risk in abdominally obese patients with type 2 diabetes or the metabolic syndrome.