OpenLB
Open Library of Bioscience
Advanced Search
Current cardiology reports
Nov, 2024;26 (11): 1309-1320.

The Role of Obesity as a Cardiac Disease Risk Factor in Patients with Type 2 Diabetes.

Sushant Koirala, Michael Sunnaa, Thomas Bernier, Ahmet Afsin Oktay
Author Information
  1. Sushant Koirala: Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
  2. Michael Sunnaa: Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
  3. Thomas Bernier: Division of Cardiology, Rush University Medical Center, Chicago, IL, 60612, USA.
  4. Ahmet Afsin Oktay: Division of Cardiology, Rush University Medical Center, Chicago, IL, 60612, USA. Ahmet_a_oktay@rush.edu.
PMID: 39235729 DOI: 10.1007/s11886-024-02129-z

Abstract

PURPOSE OF REVIEW: Cardiovascular disease (CVD) is the leading cause of death globally and is closely associated with obesity and Type 2 diabetes mellitus (T2DM). This review examines the interplay between obesity, T2DM, and CVD, highlighting the increasing prevalence and economic burden of these conditions.
RECENT FINDINGS: Pharmacologic therapies, particularly glucagon-like peptide-1 receptor agonists, show promise in substantial weight loss and subsequent reduction of adverse cardiovascular events in obese individuals with and without diabetes. obesity significantly contributes to the development of insulin resistance and T2DM, further escalating CVD risk. The common co-occurrence of these three conditions may involve several other pathophysiological mechanisms, such as chronic inflammation, increased visceral adiposity, and endothelial dysfunction. Until recently, lifestyle modifications and bariatric surgery had been the primary methods for weight loss and mitigating obesity-associated cardiovascular risk. Newer pharmacological options have led to a paradigm shift in our approach to obesity management as they provide substantial benefits in weight loss, glycemic control, and cardiovascular risk reduction.

Keywords

Cardiovascular disease Diabetes Mellitus Glucagon-like peptide-1 receptor agonist Obesity Weight loss

References

  1. Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990���2019: Update From the GBD 2019 Study. J Am Coll Cardiol 2020. https://doi.org/10.1016/j.jacc.2020.11.010 .
  2. Naghavi M, Ong KL, Aali A, et al. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990���2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. 2024. https://doi.org/10.1016/S0140-6736(24)00367-2 . [DOI: 10.1016/S0140-6736(24)00367-2]
  3. Sun F, Yao J, Du S, et al. Social Determinants, Cardiovascular Disease, and Health Care Cost: A Nationwide Study in the United States Using Machine Learning. J Am Heart Assoc. 2023. https://doi.org/10.1161/JAHA.122.027919 . [DOI: 10.1161/JAHA.122.027919]
  4. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics���2022 Update: A Report From the American Heart Association. Circulation. 2022. https://doi.org/10.1161/CIR.0000000000001052 . [DOI: 10.1161/CIR.0000000000001052]
  5. Birger M, Kaldjian AS, Roth GA, et al. Spending on Cardiovascular Disease and Cardiovascular Risk Factors in the United States: 1996 to 2016. Circulation 2021. https://doi.org/10.1161/CIRCULATIONAHA.120.053216 .
  6. Luengo-Fernandez R, Walli-Attaei M, Gray A, et al. Economic burden of cardiovascular diseases in the European Union: a population-based cost study. Eur Heart J. 2023. https://doi.org/10.1093/eurheartj/ehad583 . [DOI: 10.1093/eurheartj/ehad583]
  7. Boutari C, DeMarsilis A, Mantzoros CS. Obesity and diabetes. Diabetes Res Clin Pract. 2023. https://doi.org/10.1016/j.diabres.2023.110773 . [DOI: 10.1016/j.diabres.2023.110773]
  8. La Sala L, Pontiroli AE. Prevention of Diabetes and Cardiovascular Disease in Obesity. Int J Mol Sci. 2020. https://doi.org/10.3390/ijms21218178 . [DOI: 10.3390/ijms21218178]
  9. International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: International Diabetes Federation. 2021. https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf . Accessed 30 Aug 2024.
  10. Bhupathiraju SN, Hu FB. Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications. Circ Res. 2016. https://doi.org/10.1161/CIRCRESAHA.115.306825 . [DOI: 10.1161/CIRCRESAHA.115.306825]
  11. Stierman B, Afful J, Carroll MD, et al. National Health and Nutrition Examination Survey 2017���March 2020 Prepandemic Data Files Development of Files and Prevalence Estimates for Selected Health Outcomes. 2021.
  12. Boutari C and Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism - Clinical and Experimental 2022. https://doi.org/10.1016/j.metabol.2022.155217 .
  13. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017���2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. 2020. https://www.cdc.gov/nchs/data/databriefs/db360-h.pdf . Accessed 30 Aug 2024.
  14. Centers for Disease Control and Prevention. National Diabetes Statistics Report, https://www.cdc.gov/diabetes/php/data-research/index.html (2024, accessed July 20, 2024).
  15. Alpert MA, Lavie CJ, Agrawal H, et al. Obesity and heart failure: epidemiology, pathophysiology, clinical manifestations, and management. Transl Res. 2014. https://doi.org/10.1016/j.trsl.2014.04.010 . [DOI: 10.1016/j.trsl.2014.04.010]
  16. Bae JP, Kallenbach L, Nelson DR, et al. Obesity and metabolic syndrome in patients with heart failure with preserved ejection fraction: a cross-sectional analysis of the Veradigm Cardiology Registry. BMC Endocr Disord. 2024. https://doi.org/10.1186/s12902-024-01589-2 . [DOI: 10.1186/s12902-024-01589-2]
  17. Pich�� M, Tchernof A, Despr��s J. Obesity Phenotypes, Diabetes, and Cardiovascular Diseases. Circ Res. 2020. https://doi.org/10.1161/CIRCRESAHA.120.316101 . [DOI: 10.1161/CIRCRESAHA.120.316101]
  18. Lopez-Candales A, Hern��ndez Burgos PM, Hernandez-Suarez DF, et al. Linking chronic inflammation with cardiovascular disease: from normal aging to the metabolic syndrome. J Nat Sci. 2017;3(4):e341.
  19. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021. https://doi.org/10.1161/CIR.0000000000000973 . [DOI: 10.1161/CIR.0000000000000973]
  20. Tobias DK, Pan A, Jackson CL, et al. Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med. 2014. https://doi.org/10.1056/NEJMoa1304501 . [DOI: 10.1056/NEJMoa1304501]
  21. Brown OI, Drozd M, McGowan H, et al. Relationship Among Diabetes, Obesity, and Cardiovascular Disease Phenotypes: A UK Biobank Cohort Study. Diabetes Care. 2023. https://doi.org/10.2337/dc23-0294 . [DOI: 10.2337/dc23-0294]
  22. Pandey A, LaMonte M, Klein L, et al. Relationship Between Physical Activity, Body Mass Index, and Risk of Heart Failure. J Am Coll Cardiol. 2017. https://doi.org/10.1016/j.jacc.2016.11.081 . [DOI: 10.1016/j.jacc.2016.11.081]
  23. Singleton MJ, German CA, Soliman EZ, et al. Body Mass Index, Sex, and Incident Atrial Fibrillation in Diabetes: The ACCORD Trial. JACC: Clinical Electrophysiology 2020. https://doi.org/10.1016/j.jacep.2020.08.008 .
  24. Yun J, Ko S. Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes. Metab Clin Exp. 2021. https://doi.org/10.1016/j.metabol.2021.154838 . [DOI: 10.1016/j.metabol.2021.154838]
  25. Rawshani A, Rawshani A, Franz��n S, et al. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes. N Engl J Med. 2017. https://doi.org/10.1056/NEJMoa1608664 . [DOI: 10.1056/NEJMoa1608664]
  26. Park JH, Ha KH, Kim BY, et al. Trends in Cardiovascular Complications and Mortality among Patients with Diabetes in South Korea. Diabetes Metab J. 2021. https://doi.org/10.4093/dmj.2020.0175 . [DOI: 10.4093/dmj.2020.0175]
  27. Alebna PL, Mehta A, Yehya A, et al. Update on obesity, the obesity paradox, and obesity management in heart failure. Prog Cardiovasc Dis. 2024. https://doi.org/10.1016/j.pcad.2024.01.003 . [DOI: 10.1016/j.pcad.2024.01.003]
  28. Tutor AW, Lavie CJ, Kachur S, et al. Updates on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis. 2023. https://doi.org/10.1016/j.pcad.2022.11.013 . [DOI: 10.1016/j.pcad.2022.11.013]
  29. Fonarow GC, Srikanthan P, Costanzo MR, et al. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J. 2007. https://doi.org/10.1016/j.ahj.2006.09.007 . [DOI: 10.1016/j.ahj.2006.09.007]
  30. Hobbach AJ, Feld J, Linke WA, et al. BMI-Stratified Exploration of the ���Obesity Paradox���: Heart Failure Perspectives from a Large German Insurance Database. J Clin Med. 2024. https://doi.org/10.3390/jcm13072086 . [DOI: 10.3390/jcm13072086]
  31. Katta N, Loethen T, Lavie CJ, et al. Obesity and Coronary Heart Disease: Epidemiology, Pathology, and Coronary Artery Imaging. Curr Probl Cardiol. 2021. https://doi.org/10.1016/j.cpcardiol.2020.100655 . [DOI: 10.1016/j.cpcardiol.2020.100655]
  32. Ng ACT, Delgado V, Borlaug BA, et al. Diabesity: the combined burden of obesity and diabetes on heart disease and the role of imaging. Nat Rev Cardiol. 2021. https://doi.org/10.1038/s41569-020-00465-5 . [DOI: 10.1038/s41569-020-00465-5]
  33. Galicia-Garcia U, Benito-Vicente A, Jebari S, et al. Pathophysiology of Type 2 Diabetes Mellitus. Int J Mol Sci. 2020. https://doi.org/10.3390/ijms21176275 . [DOI: 10.3390/ijms21176275]
  34. Christensen RH, von Scholten BJ, Lehrskov LL, et al. Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes? Therapeutic advances in endocrinology and metabolism. 2020. https://doi.org/10.1177/2042018820928824 . [DOI: 10.1177/2042018820928824]
  35. Selthofer-Relati�� K, Kibel A, Deli��-Brklja��i�� D, et al. Cardiac Obesity and Cardiac Cachexia: Is There a Pathophysiological Link? Journal of obesity. 2019. https://doi.org/10.1155/2019/9854085 . [DOI: 10.1155/2019/9854085]
  36. Karlsson T, Rask-Andersen M, Pan G, et al. Contribution of genetics to visceral adiposity and its relation to cardiovascular and metabolic disease. Nat Med. 2019. https://doi.org/10.1038/s41591-019-0563-7 . [DOI: 10.1038/s41591-019-0563-7]
  37. Su Y, MD, Liu X, MD, Sun Y, MD, et al. Endothelial Dysfunction in Impaired Fasting Glycemia, Impaired Glucose Tolerance, and Type 2 Diabetes Mellitus. The American Journal of Cardiology 2008. https://doi.org/10.1016/j.amjcard.2008.03.087 .
  38. Savoia C, Sada L, Zezza L, et al. Vascular Inflammation and Endothelial Dysfunction in Experimental Hypertension. Int J Hypertens. 2011. https://doi.org/10.4061/2011/281240 . [DOI: 10.4061/2011/281240]
  39. Barton M, M.D, Husmann M, M.D and Meyer MR, M.D. Accelerated Vascular Aging as a Paradigm for Hypertensive Vascular Disease: Prevention and Therapy. Canadian journal of cardiology 2016. https://doi.org/10.1016/j.cjca.2016.02.062 .
  40. Zieman SJ, Melenovsky V and Kass DA. Mechanisms, Pathophysiology, and Therapy of Arterial Stiffness. Arteriosclerosis, Thrombosis, and Vascular Biology 2005. https://doi.org/10.1161/01.ATV.0000160548.78317.29 .
  41. Chowdhary A, Thirunavukarasu S, Jex N, et al. Coronary microvascular dysfunction is only detectable in type 2 diabetes in the presence of obesity. Eur Heart J. 2021. https://doi.org/10.1093/eurheartj/ehab724.0237 . [DOI: 10.1093/eurheartj/ehab724.0237]
  42. Straznicky NE, Lambert GW, Masuo K, et al. Blunted sympathetic neural response to oral glucose in obese subjects with the insulin-resistant metabolic syndrome. Am J Clin Nutr. 2009. https://doi.org/10.3945/ajcn.2008.26299 . [DOI: 10.3945/ajcn.2008.26299]
  43. Skyler JS, Bergenstal R, Sherwin RS, et al. Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials���: A Position Statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Cardiol. 2009. https://doi.org/10.1016/j.jacc.2008.10.008 . [DOI: 10.1016/j.jacc.2008.10.008]
  44. Arcidiacono B, Chiefari E, Foti D, et al. Type 2 diabetes mellitus and cardiovascular disease: genetic and epigenetic links. Front Endocrinol. 2018. https://doi.org/10.3389/fendo.2018.00002 . [DOI: 10.3389/fendo.2018.00002]
  45. Sanghera DK, Bejar C, Sharma S, et al. Obesity Genetics and Cardiometabolic Health: Potential for Risk Prediction. Diabetes, obesity & metabolism 2019. https://doi.org/10.1111/dom.13641 .
  46. Sarnowski C, Conomos MP, Vasan RS, et al. Genetic Effect on Body Mass Index and Cardiovascular Disease Across Generations. Circulation Genomic and precision medicine. 2023. https://doi.org/10.1161/CIRCGEN.122.003858 . [DOI: 10.1161/CIRCGEN.122.003858]
  47. American Diabetes Association Professional Practice Committee. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes���2024. Diabetes Care 2023. https://doi.org/10.2337/dc24-S005 .
  48. American Diabetes Association Professional Practice Committee. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes���2024. Diabetes Care 2023. https://doi.org/10.2337/dc24-S008 .
  49. Wing RR, Bolin P, Brancati FL, et al. Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. N Engl J Med. 2013. https://doi.org/10.1056/NEJMoa1212914 . [DOI: 10.1056/NEJMoa1212914]
  50. Huang Z, Zhuang X, Huang R, et al. Physical Activity and Weight Loss Among Adults With Type 2 Diabetes and Overweight or Obesity: A Post Hoc Analysis of the Look AHEAD Trial. JAMA Netw Open. 2024. https://doi.org/10.1001/jamanetworkopen.2024.0219 . [DOI: 10.1001/jamanetworkopen.2024.0219]
  51. Zheng X, Zhang W, Wan X, et al. The effects of Mediterranean diet on cardiovascular risk factors, glycemic control and weight loss in patients with type 2 diabetes: a meta-analysis. BMC nutrition. 2024. https://doi.org/10.1186/s40795-024-00836-y . [DOI: 10.1186/s40795-024-00836-y]
  52. Kim H, Caulfield LE, Garcia-Larsen V, et al. Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults. J Am Heart Assoc. 2019. https://doi.org/10.1161/JAHA.119.012865 . [DOI: 10.1161/JAHA.119.012865]
  53. Toumpanakis A, Turnbull T, Alba-Barba I. Effectiveness of plant-based diets in promoting well-being in the management of type 2 diabetes: a systematic review. BMJ Open Diabetes Res Care. 2018. https://doi.org/10.1136/bmjdrc-2018-000534 . [DOI: 10.1136/bmjdrc-2018-000534]
  54. Wang Y, Liu B, Han H, et al. Associations between plant-based dietary patterns and risks of type 2 diabetes, cardiovascular disease, cancer, and mortality ��� a systematic review and meta-analysis. Nutr J. 2023. https://doi.org/10.1186/s12937-023-00877-2 . [DOI: 10.1186/s12937-023-00877-2]
  55. Liu G, Hu Y, Zong G, et el. Smoking cessation and weight change in relation to cardiovascular disease incidence and mortality in people with type 2 diabetes: a population-based cohort study. Lancet Diabetes Endocrinol. 2020;8(2):125���33. https://doi.org/10.1016/S2213-8587(19)30413-9 .
  56. Doughty KN, Del Pilar NX, Audette A, et al. Lifestyle Medicine and the Management of Cardiovascular Disease. Curr Cardiol Rep. 2017. https://doi.org/10.1007/s11886-017-0925-z . [DOI: 10.1007/s11886-017-0925-z]
  57. American Diabetes Association Professional Practice Committee. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes���2024. Diabetes Care 2023. https://doi.org/10.2337/dc24-S009 .
  58. Marx N, Husain M, Lehrke M, et al. GLP-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes. Circulation. 2022;146(24):1882���94. https://doi.org/10.1161/CIRCULATIONAHA.122.059595 .
  59. Drucker DJ. The Cardiovascular Biology of Glucagon-like Peptide-1. Cell Metab. 2016;24:15. [DOI: 10.1016/j.cmet.2016.06.009]
  60. Meier JJ. GLP-1 receptor agonists for individualized treatment of type 2 diabetes mellitus. Nat Rev Endocrinol. 2012. https://doi.org/10.1038/nrendo.2012.140 . [DOI: 10.1038/nrendo.2012.140]
  61. Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375:311. [DOI: 10.1056/NEJMoa1603827]
  62. Marso SP, Bain SC, Consoli A, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016;375:1834. [DOI: 10.1056/NEJMoa1607141]
  63. Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. The Lancet. 2019;394:121. [DOI: 10.1016/S0140-6736(19)31149-3]
  64. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389:2221. [DOI: 10.1056/NEJMoa2307563]
  65. Kosiborod MN, Abildstr��m SZ, Borlaug BA, et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2023;389:1069. [DOI: 10.1056/NEJMoa2306963]
  66. Kosiborod MN, Petrie MC, Borlaug BA, et al. Semaglutide in Patients with Obesity-Related Heart Failure and Type 2 Diabetes. N Engl J Med. 2024. https://doi.org/10.1056/nejmoa2313917 . [DOI: 10.1056/nejmoa2313917]
  67. Ceriello A, Novials A, Ortega E, et al. Glucagon-Like Peptide 1 Reduces Endothelial Dysfunction, Inflammation, and Oxidative Stress Induced by Both Hyperglycemia and Hypoglycemia in Type 1 Diabetes. Diabetes Care. 2013;36:2346. [DOI: 10.2337/dc12-2469]
  68. Ceriello A, Novials A, Canivell S, et al. Simultaneous GLP-1 and Insulin Administration Acutely Enhances Their Vasodilatory, Antiinflammatory, and Antioxidant Action in Type 2 Diabetes. Diabetes Care. 2014. https://doi.org/10.2337/dc13-2618 . [DOI: 10.2337/dc13-2618]
  69. Hogan AE, Gaoatswe G, Lynch L, et al. Glucagon-like peptide 1 analogue therapy directly modulates innate immune-mediated inflammation in individuals with type 2 diabetes mellitus. Diabetologia. 2013;57:781. [DOI: 10.1007/s00125-013-3145-0]
  70. Woo JS, Kim W, Ha SJ, et al. Cardioprotective effects of exenatide in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention: results of exenatide myocardial protection in revascularization study. Arterioscler Thromb Vasc Biol. 2013. https://doi.org/10.1161/ATVBAHA.113.301586 . [DOI: 10.1161/ATVBAHA.113.301586]
  71. Chen WR, Hu SY, Chen YD, et al. Effects of liraglutide on left ventricular function in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am Heart J. 2015;170:845. [DOI: 10.1016/j.ahj.2015.07.014]
  72. Sano R, Shinozaki Y, Ohta T. Sodium���glucose cotransporters: Functional properties and pharmaceutical potential. J of Diabetes Invest. 2020;11:770. [DOI: 10.1111/jdi.13255]
  73. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377:644. [DOI: 10.1056/NEJMoa1611925]
  74. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380:347. [DOI: 10.1056/NEJMoa1812389]
  75. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373:2117. [DOI: 10.1056/NEJMoa1504720]
  76. Cardoso R, Graffunder FP, Ternes CMP, et al. SGLT2 inhibitors decrease cardiovascular death and heart failure hospitalizations in patients with heart failure: a systematic review and meta-analysis. EClinicalMedicine 2021;36:100933. https://doi.org/10.1016/j.eclinm.2021.100933 .
  77. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022. https://doi.org/10.1056/nejmoa2206038 . [DOI: 10.1056/nejmoa2206038]
  78. Garvey T, Frias JP, Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2023;402(10402):613���26. https://doi.org/10.1016/S0140-6736(23)01200-X .
  79. Fr��as JP, Davies MJ, Rosenstock J, et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med. 2021;385:503. [DOI: 10.1056/NEJMoa2107519]
  80. Mentias A, Aminian A, Youssef D, et al. Long-Term Cardiovascular Outcomes After Bariatric Surgery in the Medicare Population. J Am Coll Cardiol. 2022. https://doi.org/10.1016/j.jacc.2022.01.047 . [DOI: 10.1016/j.jacc.2022.01.047]
  81. Fisher DP, Johnson E, Haneuse S, et al. Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity. JAMA, J Am Med Assoc. 2018. https://doi.org/10.1001/jama.2018.14619 . [DOI: 10.1001/jama.2018.14619]
  82. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes ��� 5-Year Outcomes. N Engl J Med. 2017. https://doi.org/10.1056/nejmoa1600869 . [DOI: 10.1056/nejmoa1600869]
  83. Ikramuddin S, Korner J, Lee W, et al. Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c, LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study. JAMA, J Am Med Assoc. 2018. https://doi.org/10.1001/jama.2017.20813 . [DOI: 10.1001/jama.2017.20813]
  84. Aminian A, Zajichek A, Arterburn DE, et al. Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity. JAMA. 2019. https://doi.org/10.1001/jama.2019.14231 . [DOI: 10.1001/jama.2019.14231]
  85. Courcoulas AP, Patti ME, Hu B, et al. Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. JAMA, J Am Med Assoc. 2024. https://doi.org/10.1001/jama.2024.0318 . [DOI: 10.1001/jama.2024.0318]

MeSH Term

Humans
Diabetes Mellitus, Type 2
Obesity
Cardiovascular Diseases
Heart Disease Risk Factors
Weight Loss
Bariatric Surgery
Insulin Resistance
Hypoglycemic Agents
Risk Factors
Glucagon-Like Peptide-1 Receptor Agonists

Chemicals

Hypoglycemic Agents
Glucagon-Like Peptide-1 Receptor Agonists
Journal Article Review

Word Cloud

Created with Highcharts 10.0.0lossCVDobesityT2DMweightcardiovascularObesityriskCardiovasculardisease2diabetesconditionspeptide-1receptorsubstantialreductionDiabetesPURPOSEOFREVIEW:leadingcausedeathgloballycloselyassociatedtypemellitusreviewexaminesinterplayhighlightingincreasingprevalenceeconomicburdenRECENTFINDINGS:Pharmacologictherapiesparticularlyglucagon-likeagonistsshowpromisesubsequentadverseeventsobeseindividualswithoutsignificantlycontributesdevelopmentinsulinresistanceescalatingcommonco-occurrencethreemayinvolveseveralpathophysiologicalmechanismschronicinflammationincreasedvisceraladiposityendothelialdysfunctionrecentlylifestylemodificationsbariatricsurgeryprimarymethodsmitigatingobesity-associatedNewerpharmacologicaloptionsledparadigmshiftapproachmanagementprovidebenefitsglycemiccontrolRoleCardiacDiseaseRiskFactorPatientsTypeMellitusGlucagon-likeagonistWeight

Similar Articles

Cited By (2)