Obesity, metabolic syndrome, and coronary atherosclerosis.

Abstract

The relationship between obesity and coronary atherosclerosis (and coronary heart disease [CHD]) has been a subject of some dispute for many years. Data from early investigations suggested that obesity is not an important contributing cause of coronary atherosclerosis and CHD. For example, results of the Seven Countries Study1 revealed little correlation between body weight and incidence of CHD. Moreover, in the massive autopsy study called “The Geographic Pathology of Atherosclerosis,” edited by Henry C. McGill, Jr,2 the relationship between body weight and atherosclerosis was weak at best. This study included a detailed examination of arteries from a large number of autopsies carried out in New Orleans, Sao Paulo, Puerto Rico, Lima, and Santiago; by and large, the results uncovered no association between extent of arterial fatty streaks or raised atherosclerotic lesions in either the coronary arteries or the aorta for any measure of body weight, height, or obesity.3 It was noted that this study had the advantage of including several groups that differed greatly in geographic origin, ethnicity, CHD morbidity, and severity of atherosclerosis. Although the authors3 conceded that obesity is a factor contributing to risk factors for CHD such as hypertension, they surmised that the relationship between obesity and other risk factors is too weak for obesity to have a detectable effect on the severity of atherosclerosis. See p 2712 In spite of these earlier negative findings, the Framingham Heart Study in the United States has consistently shown that increasing degrees of obesity are accompanied by greater rates of CHD.4,5⇓ Even so, multivariate analysis of Framingham data strongly suggests that most of the relationship between body weight and CHD risk is mediated through the standard, major risk factors, ie, blood pressure, total cholesterol, HDL cholesterol, and diabetes.6 Their own data led Framingham …