DOI: 10.1097/HJH.0b013e328330e8ae

,  

,  

PMID: 19692848

Issn Print: 0263-6352

Publication Date: 2009/09/01


Print

Obesity-related cardiac and vascular structural alterations: beyond blood pressure overload

Guido Grassi; Javier Diez

+ Author Information

Author Information: Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Monza (Milan), Italy

    loading  Checking for direct PDF access through Ovid

Excerpt

Studies performed in the past few years have convincingly documented the adverse impact the obese state carries on cardiovascular morbidity and mortality with particular reference to congestive heart failure, myocardial infarction and renal failure as well [1–3]. Data recently collected in the context of the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study have reinforced the results of the above-mentioned studies, by showing, for example, that the occurrence of an obese state is an important predictor of cardiovascular events in the general population living in northern Italy, Brianza area, even when data are adjusted for confounders such as age and clinic blood pressure values (Mancia G, Grassi G, et al., unpublished observations). Interestingly, similar conclusions can be achieved when the data are adjusted for 24-h ambulatory blood pressure values, suggesting that extrahaemodynamic factors participate at the obesity-related increase in cardiac mass. Despite the large amount of data collected in the past years, several aspects related to this issue still remain far from being fully elucidated. These include, for example, the pathophysiology of obesity-related left ventricular hypertrophy. They also include, however, other aspects such as the relative weight of haemodynamic vs. nonhaemodynamic factors in the development and progression of the cardiac structural changes; the role of neurohumoral factors in the pathophysiology of this complication; and the clinical impact of different types of cardiac structural alterations reported in the obese state.
In the present issue of the Journal, Norton et al. [4] report the results of a study designed at determining whether and to what extent the impact of hypertension on left ventricular mass can be in some way affected by the presence of an obese state. To this aim, about 400 individuals belonging to the general population living in the outskirts of Johannesburg, South Africa, were cross-sectionally examined by performing a number of clinical and instrumental evaluations. These included clinic and 24-h ambulatory blood pressure, demographic and anthropometric variables, humoral data (e.g. leptin), carotid pulse pressure wave analysis and echocardiographically determined left ventricular mass as well. Three are the main study findings. First, confirming data collected in a previous study [5], the authors found a direct and highly significant relationship between BMI, waist circumference or mean skin-fold thickness and various haemodynamic variables, such as clinic blood pressure, 24-h blood pressure as well as pulse pressure. Second, different indices of adipose tissue depot appear to play a major role in determining cardiac and vascular structural alterations, by potentiating and amplifying the prohypertrophic effects a stable blood pressure elevation has on cardiac wall thickness and pulse wave velocity. Finally, leptin is suggested to represent one of the major pathophysiological links between the abnormal adipose tissue depot and the development and progression of the cardiac structural changes.

Related Topics

    loading  Loading Related Articles