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 .
Adverse consequences of high sympathetic nervous activity in the failing human heart.
OBJECTIVES In view of previous experimental evidence relating sympathetic nervous overactivity in the heart to myocardial necrosis and ventricular arrhythmias , we prospect ively examined the hypothesis that heightened cardiac sympathetic nervous activity is associated with an adverse outcome in patients with moderate to severe heart failure . BACKGROUND Despite recent therapeutic advances , patients with heart failure continue to have high mortality from progressive hemodynamic decompensation and lethal ventricular arrhythmias . It is believed that initially compensatory increases in sympathetic nervous system activity may ultimately be maladaptive , potentially contributing to subsequent adverse events . METHODS Sixty patients with moderate to severe heart failure ( left ventricular ejection fraction 18.9 + /- 0.9 % [ mean + /- SE ] ) were studied prospect ively . In addition to the compilation of a hemodynamic , biochemical and electrocardiographic profile for each patient , whole-body and cardiac sympathetic activity were determined by isotope dilution . The relation of these variables to outcome was determined by Cox proportional hazards analysis . RESULTS The mean follow-up period of the study group was 7 + /- 1 months ( range 1 to 24 ) with a 12-month actuarial survival of 75 % . Deaths ( 14 in all ) were accounted for either by sudden death or progressive heart failure in equal numbers . The rate of release of norepinephrine from the heart was significantly higher in patients with heart failure than in healthy subjects ( 402 + /- 37 vs. 105 + /- 19 pmol/min , p < 0.01 ) , although the values for heart failure ranged widely from normal to 10 times normal . By univariate Cox proportional hazards analysis , pulmonary capillary wedge pressure ( p < 0.01 ) , mean pulmonary artery pressure ( p < 0.001 ) , serum sodium levels ( p < 0.01 ) and cardiac norepinephrine spill-over rate ( p < 0.001 ) were identified as significant prognostic markers . In a multivariate analysis , cardiac norepinephrine spillover rate was identified as the most powerful prognostic marker ( p = 0.0006 ) of those evaluated in this study . CONCLUSIONS These results suggest that activation of the sympathetic nervous system in patients with heart failure , specifically the cardiac sympathetic nerves , may contribute to the poor prognosis associated with severe heart failure . The data therefore provide a rationale for the use of drugs such as beta-adrenergic blocking agents in the management of patients with heart failure
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 .