This indicates that even in the absence of metabolic abnormalities , overweight and obesity are not innocuous , perhaps because the traditional cardiovascular risk factors are either not present early or remain undetected using routine clinical assessment .
This raises the concept that early or sub clinical organ damage assessment s may be better at identifying subjects who are more likely to progress to develop cardiovascular disease .
Obesity and Consequences The prevalence of overweight and obesity has reached epidemic proportion , with the recent figures from the World Health Organization indicating that in 2016 39 % of adults aged ≥18 years ( 39 % of men and 40 % of women ) were overweight and 13 % ( 11 % of men and 15 % of women ) obese .
The World Health Organization states that raised body mass index ( BMI ) is a major risk factor for noncommunicable diseases such as cardiovascular diseases ( mainly heart disease and stroke ) , which were the leading causes of death in 2012 , diabetes mellitus , musculoskeletal disorders , and some cancers .
The Framingham Heart Study data have indicated that overweight and obesity are associated with significantly decreased life expectancy .
Nevertheless , and against these strong evidence s , the relationship between BMI and mortality has been challenged by several studies , indicating a survival advantages for those who are overweight and class I obese .
However , the determinants of these observations are poorly understood and continue to be debated because BMI may not be the ideal index of adiposity and fat distribution and fitness and disease prevention may obscure the link between BMI and mortality .
Overweight or obesity is not always accompanied by traditional risk factors .
In fact , a systematic review and meta analysis revealed that about 35 % of obese individuals are metabolically healthy .
There is evidence that an important factor driving at least some of the obesity-associated end-organ damage is overactivity of the sympathetic nervous system ( SNS ) , an observation that suggests that targeting SNS in obesity may help reduce the cardiovascular risk associated with obesity .
In this review , we highlight the current knowledge of the potential role of SNS function in obesity-induced organ damage and examine whether interventions aim ed at reducing cardiovascular risk in obesity may be mediated via alterations in SNS activity .
Cardiovascular Safety of Lorcaserin in Overweight or Obese Patients
Background Lorcaserin , a selective serotonin 2C receptor agonist that modulates appetite , has proven efficacy for weight management in overweight or obese patients . The cardiovascular safety and efficacy of lorcaserin are undefined . Methods We r and omly assigned 12,000 overweight or obese patients with atherosclerotic cardiovascular disease or multiple cardiovascular risk factors to receive either lorcaserin ( 10 mg twice daily ) or placebo . The primary safety outcome of major cardiovascular events ( a composite of cardiovascular death , myocardial infa rct ion , or stroke ) was assessed at an interim analysis to exclude a noninferiority boundary of 1.4 . If noninferiority was met , the primary cardiovascular efficacy outcome ( a composite of major cardiovascular events , heart failure , hospitalization for unstable angina , or coronary revascularization [ extended major cardiovascular events ] ) was assessed for superiority at the end of the trial . Results At 1 year , weight loss of at least 5 % had occurred in 1986 of 5135 patients ( 38.7 % ) in the lorcaserin group and in 883 of 5083 ( 17.4 % ) in the placebo group ( odds ratio , 3.01 ; 95 % confidence interval [ CI ] , 2.74 to 3.30 ; P<0.001 ) . Patients in the lorcaserin group had slightly better values with respect to cardiac risk factors ( including blood pressure , heart rate , glycemic control , and lipids ) than those in the placebo group . During a median follow‐up of 3.3 years , the rate of the primary safety outcome was 2.0 % per year in the lorcaserin group and 2.1 % per year in the placebo group ( hazard ratio , 0.99 ; 95 % CI , 0.85 to 1.14 ; P<0.001 for noninferiority ) ; the rate of extended major cardiovascular events was 4.1 % per year and 4.2 % per year , respectively ( hazard ratio , 0.97 ; 95 % CI , 0.87 to 1.07 ; P=0.55 ) . Adverse events of special interest were uncommon , and the rates were generally similar in the two groups , except for a higher number of patients with serious hypoglycemia in the lorcaserin group ( 13 vs. 4 , P=0.04 ) . Conclusions In a high‐risk population of overweight or obese patients , lorcaserin facilitated sustained weight loss without a higher rate of major cardiovascular events  than that with placebo . ( Funded by Eisai ; CAMELLIA – TIMI 61 Clinical Trials.gov number , NCT02019264 .
This indicates that even in the absence of metabolic abnormalities , overweight and obesity are not innocuous , perhaps because the traditional cardiovascular risk factors are either not present early or remain undetected using routine clinical assessment .
This raises the concept that early or sub clinical organ damage assessment s may be better at identifying subjects who are more likely to progress to develop cardiovascular disease .
Obesity and Consequences The prevalence of overweight and obesity has reached epidemic proportion , with the recent figures from the World Health Organization indicating that in 2016 39 % of adults aged ≥18 years ( 39 % of men and 40 % of women ) were overweight and 13 % ( 11 % of men and 15 % of women ) obese .
The World Health Organization states that raised body mass index ( BMI ) is a major risk factor for noncommunicable diseases such as cardiovascular diseases ( mainly heart disease and stroke ) , which were the leading causes of death in 2012 , diabetes mellitus , musculoskeletal disorders , and some cancers .
The Framingham Heart Study data have indicated that overweight and obesity are associated with significantly decreased life expectancy .
Nevertheless , and against these strong evidence s , the relationship between BMI and mortality has been challenged by several studies , indicating a survival advantages for those who are overweight and class I obese .
However , the determinants of these observations are poorly understood and continue to be debated because BMI may not be the ideal index of adiposity and fat distribution and fitness and disease prevention may obscure the link between BMI and mortality .
Overweight or obesity is not always accompanied by traditional risk factors .
In fact , a systematic review and meta analysis revealed that about 35 % of obese individuals are metabolically healthy .
There is evidence that an important factor driving at least some of the obesity-associated end-organ damage is overactivity of the sympathetic nervous system ( SNS ) , an observation that suggests that targeting SNS in obesity may help reduce the cardiovascular risk associated with obesity .
In this review , we highlight the current knowledge of the potential role of SNS function in obesity-induced organ damage and examine whether interventions aim ed at reducing cardiovascular risk in obesity may be mediated via alterations in SNS activity .