Obesity-related chronic diseases: cardiovascular and metabolic diseases
In 2016, the American Association of Clinical Endocrinology (AACE) proposed renaming obesity as obesity-related chronic diseases (ABCD) to reflect its role as a common pathological basis for various diseases, including cardiovascular, endocrine, and oncological disorders. In my country, cardiovascular disease accounts for over 40% of deaths. Data shows that more than 90% of obese individuals also suffer from hypertension and dyslipidemia, and those with abdominal obesity have a more than four times higher risk of developing hypertension than those with normal weight.
The mechanisms by which obesity leads to hypertension involve sympathetic hyperactivity, RAAS system activation, vascular endothelial abnormalities, and sodium and water retention. Coronary artery disease originates from lipid metabolism abnormalities, oxidative stress, and inflammatory responses caused by fat accumulation. These factors promote atherosclerosis, leading to luminal narrowing and myocardial ischemia. Stroke, as an independent risk factor for obesity, is often accompanied by sleep apnea and metabolic disorders. In terms of treatment, a weight loss of ≥5% can reduce the risk of complications. ACEIs and ARBs are first-line drugs for hypertension combined with obesity because they can improve insulin resistance.
In terms of metabolic diseases, obesity is a core contributing factor to type 2 diabetes, gout, and lipid metabolism disorders. The prevalence of type 2 diabetes in overweight and obese individuals is 12.8% and 18.5%, respectively. Severe insulin resistance caused by visceral obesity ultimately leads to pancreatic β-cell dysfunction. For obese patients with diabetes, hypoglycemic agents with weight-loss effects, such as biguanides, SGLT-2 inhibitors, or GLP-1 receptor agonists, are preferred.
Gout is also closely related to obesity. The prevalence of hyperuricemia is as high as 37.1% in individuals with a BMI > 25 kg/m². Obesity-induced insulin resistance reduces the kidneys' clearance of uric acid, and excessive energy intake leads to increased purine synthesis. For treatment, colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs) can be used in the acute phase. Uric acid-lowering regimens include allopurinol, febuxostatin, and benzbromarone, which promotes uric acid excretion. Lipid metabolism abnormalities manifest as elevated triglycerides (TG) and decreased HDL-c; statins are the first-line lipid-lowering drugs.
Metabolic syndrome (MS) is a clinical condition characterized by obesity, impaired glucose tolerance, hypertension, and abnormal lipid metabolism. Central obesity is not only a component of MS but also a key driver of other metabolic abnormalities. The control goals for MS are clearly defined: a 7%–10% weight loss within one year; fasting blood glucose < 6.1 mmol/L; glycated hemoglobin < 7.0%; and blood pressure targets of < 130/80 mmHg for diabetic patients and < 140/90 mmHg for non-diabetic patients.
For refractory obesity that does not respond well to lifestyle and drug interventions, surgical treatment may be considered. Orlistat is currently the only approved weight-loss drug in my country, which reduces fat absorption by inhibiting gastrointestinal lipases. In addition, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass are important means of improving metabolic indicators. In summary, the ABCD framework emphasizes the urgency of obesity management; early intervention in this core pathological aspect can effectively prevent and control various chronic complications.
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