Obesity: Pathology and Therapy
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Medium-term risk should be evaluated using risk prediction models adapted whenever possible to the local population, and the possibility of sub-clinical vasculopathy should be investigated using the appropriate procedures.. Signs of asymptomatic vasculopathy can be studied in all in vascular territories mostly affected by atherosclerosis Table 4.
The possibility of an effect on cerebral blood flow can be studied by determining the intima media thickness of the common carotid artery, while the impact on peripheral circulation is measured most precisely using abdominal ultrasound to determine the diameter of the aorta. The ankle-brachial index can also be used as a non-invasive method to detect peripheral vascular disease, which correlates with vascular risk. Other, more general signs of sub-clinical vasculopathy are microalbuminuria and erectile dysfunction.
Diabetes is now considered a vascular disease even when it clinical complications are not present. This approach is clearly important from the treatment point of view, though it is more doubtful when it comes to diagnosis, and has led to disagreement with the European Society of Cardiology's clinical practice guidelines on diabetes and pre-diabetes which strongly recommend that tests to detect myocardial ischemia are performed on all patients with DM2. Table 5 provides a summary of the general approach to treating the metabolic syndromes. Lifestyle is key to the treatment of DM2, MS, and obesity.
The three basic components in any such improvement are diet, exercise, and behavior.. The first essential step is weight loss Figure 5. This apparently simple step which is in fact the most difficult to achieve and, therefore, the least frequently achieved has demonstrated numerous beneficial effects: it reduces mortality, improves lipid profiles, reduces blood pressure and left ventricle mass in hypertension, and it reduces inflammation markers in DM2.
Furthermore, in patients with MS it has been shown that it slows progression to DM2. As well as the quantitative aspect of a reduction in caloric uptake, dietary composition can also affect vascular health. Avoiding fats other than those from olive oil, increasing the consumption of fruits, vegetables, and whole-food cereals, avoiding industrially sweetened products and fatty meats, and eating white and especially blue fish are some of the recommendations in this regard Table 6.
Exercise has similar beneficial effects in MS, obesity, and DM2. As well as helping to achieve and maintain weight loss, it also reduces all of the components of MS and reduces the incidence of CVD. It may be stating the obvious to insist that patients should be encouraged to give up smoking, but it is not enough only to offer advice; health care professionals should ensure they provide the requisite support for stopping smoking at all levels of cardiovascular risk..
Treatment of High Blood Pressure. The same values are recommended for patients with MS. Angiotensin converting enzyme ACE inhibitors have demonstrated multiple beneficial effects on cardiovascular complications and for that reason are considered the first line, or preferred treatment for high blood pressure, particularly when established or incipient kidney disease is present.
Beta-blockers are indicated where coronary artery disease or heart failure are present. Diuretics showed a satisfactory anti-hypertensive effect in some studies, 38 though they also led to a worsened metabolic status 39 and have no effect on arterial rigidity. For these reasons, beta-blockers and diuretics are considered complementary to ACE inhibitors and calcium channel blockers, with which they can be carefully used in combination to achieve appropriate levels of blood pressure control..
Lipid-Lowering Treatment. Figure 8. Statins are the drug of choice to lower LDL levels. The dose should be based on the size of the reduction required in LDL cholesterol. Any of the drugs in the group should be suitable; the important thing is to pursue and achieve the required dose and the targets set.. Fibrates are considered more effective than statins in lowering triglyceride and raising HDL levels, due to their agonist effect on PPARa.
They might therefore appear to be an ideal treatment for atherogenic dyslipidemia in diabetes mellitus. This has led to its usefulness as a preventive treatment being questioned. The primary indication for niacin, which is not available in Spain, is to increase HDL concentrations, usually in combination with a statin. This is particularly true in polymedicated patients or those who have renal dysfunction.
Antiplatelet Treatment. Diabetes, MS, and even obesity are all prothrombotic conditions, with hyperaggregability and hypofibrinolysis. Acetylsalicylic acid has been shown to prevent atherothrombotic complications. Figure 9. Overview of preventive treatment in patients with diabetes, 26 also applicable in metabolic syndrome. There is little data available on treatment strategies in patients with MS with respect to control of the carbohydrate mechanism. The most appropriate drugs in obesity and MS are acarbose, metformin, and the glitazones, administered alone or in combination depending on the circumstances.
Figure HbA 1c , glycohemoglobin.. To date, only sibutramin and orlistat have been approved for use, though both have poor outcomes and are only moderately well-tolerated. Rimonabant is a selective CB1 receptor blocker which has proven effective in achieving substantial weight loss and in reducing triglyceride levels and glycohemoglobin. It has also been shown to increase HDL cholesterol levels in obese patients and specifically in patients with diabetes. Bariatric surgery is indicated in morbidly obese patients or, in less advanced cases, when CVD or diabetes are also present.
Vascular Complications. Peripheral vascular complications should be managed using percutaneous or surgical procedures corresponding to the condition in question.. As regards cardio-ischemic complications, treatment should be similar to that used in any other case of chronic angina. Antianginal drugs and revascularization will be used depending on level of functioning and coronary anatomy.
The classic antianginal drugs nitrates, beta blockers, and calcium antagonists can all be used in patients with MS, obesity, or DM2. In acute coronary syndromes, strict glucose control using insulin perfusion is essential and has been shown to reduce the incidence of some adverse outcomes. Criteria for revascularization in patients with DM2 are influenced by the greater risk which requires the use of more intensive treatments and lower success rates associated with revascularization procedures in these patients.
Obesity is a serious medical problem that affects millions of people, especially in Western societies. Although long considered a complicating factor in a variety. Body-weight loss often fails after discontinuation of life-style and therapeutic efforts. This article tries to shed new light on obese pathology and treatment study .
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Obesity Research & Clinical Practice
TABLE 1. TABLE 5. Obesity, metabolic syndrome and type-2 diabetes mellitus are three interrelated conditions that share a number of pathophysiological mechanisms and that are frequently observed to lead, in succession, to cardiovascular complications. The fact that their prevalence is increasing alarmingly should prompt all healthcare professionals urgently to implement measures to prevent these complications. The most effective, though also the least adopted, are those related to lifestyle modification. Drug treatment targeted at controlling risk factors e. Palabras clave:.
Texto completo.
- Obesity: Pathophysiology and Intervention.
- Pathology and treatments of obesity.
- About Obesity.
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Classification of type 2 diabetes mellitus
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Obesity: Pathophysiology and Intervention
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