Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy.
Department of Clinical, Internal Medicine, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
Nutrients. 2024 Aug 20;16(16):2781. doi: 10.3390/nu16162781.
Obesity is an epidemic worldwide. Overweight and multiple obesity-related mechanisms, including dysmetabolic alterations, contribute to cardiovascular deleterious effects. Hence, overweight and obesity have been independently associated with increased cardiovascular risk, whose assessment is crucial for preserving life quality and reducing mortality, and to address appropriate therapeutic strategies in obese patients. Beyond the standard of care in managing overweight and obesity in adults (i.e., diet and physical exercise), several relevant pharmacotherapies have been approved, and several procedures and device types for weight loss have been recommended. In such a contest, medical weight management remains one option for treating excess weight. Most drugs used for obesity reduce appetite and increase satiety and, secondarily, slow gastric emptying to reduce body weight and, therefore, act also to improve metabolic parameters. In this contest, agonists of the glucagon-like peptide-1 receptor (GLP-1RAs) modulate different metabolic pathways associated with glucose metabolism, energy homeostasis, antioxidation, and inflammation. Moreover, this class of drugs has shown efficacy in improving glycemic control, reducing the incidence of cardiovascular events in type 2 diabetic patients, and reducing body weight independently of the presence of diabetes. Recently, in overweight or obese patients with pre-existing cardiovascular disease but without diabetes, the GLP-1RA semaglutide reduced the incidence of cardiovascular and cerebrovascular events and death from cardiovascular causes. Thus, semaglutide has been approved for secondary prevention in obese people with cardiovascular disease. Nevertheless, whether this class of drugs is equally effective for primary prevention in obese people has to be demonstrated. In this review, we will summarize updates on the pathophysiology of obesity, the effects of obesity on cardiovascular risk, the impact of different obesity phenotypes on cardiovascular diseases, and the novelties in the clinical management of obesity for cardiovascular prevention.
肥胖是一个全球性的流行病。超重和多种与肥胖相关的机制，包括代谢紊乱改变，导致心血管不良影响。因此，超重和肥胖与心血管风险增加独立相关，其评估对于维持生活质量和降低死亡率以及为肥胖患者制定适当的治疗策略至关重要。除了成人超重和肥胖管理的标准治疗方法（即饮食和体育锻炼）之外，已经批准了几种相关的药物治疗方法，并推荐了几种减肥程序和设备类型。在这种情况下，医学体重管理仍然是治疗超重的一种选择。大多数用于肥胖的药物通过减少食欲和增加饱腹感，并其次减缓胃排空来减轻体重，从而改善代谢参数。在这种情况下，胰高血糖素样肽-1 受体（GLP-1RAs）激动剂调节与葡萄糖代谢、能量平衡、抗氧化和炎症相关的不同代谢途径。此外，这类药物已显示出在改善血糖控制、降低 2 型糖尿病患者心血管事件的发生率以及独立于糖尿病存在降低体重方面的疗效。最近，在有心血管疾病但无糖尿病的超重或肥胖患者中，GLP-1RA 司美格鲁肽降低了心血管和脑血管事件以及心血管原因导致的死亡的发生率。因此，司美格鲁肽已被批准用于有心血管疾病的肥胖人群的二级预防。然而，需要证明这类药物在肥胖人群中的一级预防是否同样有效。在这篇综述中，我们将总结肥胖的病理生理学、肥胖对心血管风险的影响、不同肥胖表型对心血管疾病的影响以及肥胖心血管预防的临床管理的最新进展。
