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 .
Comparative effects of candesartan and hydrochlorothiazide on blood pressure, insulin sensitivity, and sympathetic drive in obese hypertensive individuals: results of the CROSS study
Objective The increase in blood pressure that accompanies the obese state is almost invariably associated with alterations in metabolism ( insulin resistance and dyslipidaemia ) and the neurohumoral profile ( activation of the renin – angiotensin system , sympathetic overactivity ) , which potentiate the cardiovascular risk associated with hypertension . However , debate remains as to the antihypertensive drug on which treatment of obesity-related hypertension should be based . The CROSS ( C and esartan Role on Obesity and on Sympathetic System ) study was undertaken to examine the antihypertensive , neuroadrenergic , and metabolic effects of an angiotensin II receptor blocker in comparison with a diuretic in obese hypertensive individuals . Methods In 127 obese hypertensive individuals aged 50.7 ± 5.1 years ( mean ± SD ) , we measured clinic blood pressure , heart rate , plasma glucose , and insulin at rest and during an oral glucose load before and 12 weeks after treatment with either c and esartan cilexetil ( 8–16 mg once daily ) or hydrochlorothiazide ( HCTZ , 25–50 mg once daily ) , administered orally in accordance with a double-blind , r and omized , placebo-controlled , two-parallel-groups study design . Insulin sensitivity was expressed as insulin resistance index ( IRI ) , calculated as the ratio of the area under the curve ( AUC ) for glucose to that for insulin . In a subgroup of patients , measurements also included direct microneurographic recording of muscle sympathetic nerve activity ( MSNA ) in the peroneal nerve . Results C and esartan cilexetil caused a significant ( P < 0.01 ) reduction in both mean blood pressure ( from 114.2 ± 5.1 to 99.6 ± 6.0 mmHg ) and MSNA ( from 51.0 ± 12.3 to 40.4 ± 12.5 bursts per 100 heart beats ) , and a significant ( P < 0.02 ) increase in insulin sensitivity ( AUC IRI : from −23.2 ± 22.1 to −17.6 ± 12.2 ) . In contrast , HCTZ did not significantly affect MSNA and worsened insulin sensitivity , while achieving blood pressure reductions similar to those produced by c and esartan cilexetil . Conclusions These data provide evidence that , in obese hypertensive individuals , treatment with c and esartan cilexetil has an antihypertensive effect similar to that of HCTZ . Unlike diuretic treatment , however , treatment with c and esartan cilexetil improves insulin sensitivity and exerts sympathoinhibitory effects
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 .