Obesity and vascular disease

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Abstract
Previous articles in this series have discussed the relation of overweight and obesity with coronary heart disease (CHD) and individual cardiovascular disease risk factors—such as diabetes, raised blood pressure, and dyslipidaemia. This article examines the wider impact of obesity on vascular disease: the effect on cardiovascular disease of obesity as primary cause of the metabolic syndrome and of obesity as a risk factor for heart failure, stroke, other vascular conditions, and cognitive decline. #### Definitions of insulin resistance ##### Broad definition Insulin resistance is a clinical state in which a normal or raised insulin level produces an impaired biological response. As insulin has a number of physiological actions—including a central role in acute metabolic actions and growth and development—insulin resistance could mean impairment in any of these actions ##### Specific definition in relation to metabolic syndrome Insulin resistance, when used to identify those at risk of type 2 diabetes and as a component of the metabolic syndrome, usually refers to resistance to insulin's ability to stimulate glucose uptake in insulin sensitive peripheral tissues and its ability to suppress hepatic glucose production, promote glucose storage, inhibit ketogenesis, and suppress lipolysis The metabolic syndrome refers to the clustering within individuals of several CHD risk factors—including glucose intolerance, dyslipidaemia, and raised blood pressure—believed to be linked by a common pathophysiological process. Individuals may develop these factors in different orders, with different severities, and at different ages, but they are unified by the fact that adult weight gain is a risk factor in their development. Reaven suggested in 1988 that insulin resistance was important in causing these risk factors, but others have concluded that obesity, particularly intra-abdominal fat accumulation, is probably a common primary cause. Environmental exposures throughout life (such as high fat, energy dense diets; low levels of physical activity in childhood and adulthood; and factors related to poor intrauterine growth) also contribute to development of the metabolic syndrome. …

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