Interventions to address cardiovascular risk in patients with obesity

Leading medical associations are calling on primary care practitioners (PCPs) to be proactive in preventing cardiovascular disease (CVD) to reduce the number of premature deaths from heart attacks and strokes.^1–3 Major international guidelines now emphasise the role of obesity in cardiovascular disease and advocate healthy lifestyles: via nutrition, exercise, weight loss, smoking cessation and management of dyslipidaemia, hypertension and/or diabetes.^1–3 GPs should be promoting these goals to their patients and prescribing appropriate, evidence-based medicines where indicated.^3,4

Guidelines recommend weight loss in patients with cardiovascular disease and obesity ^1,2

Recent statements by leading cardiology societies in both Europe and the United States are emphasising the need for obesity and weight loss to be given a higher priority in the management of patients with established cardiovascular disease (CVD).^1,2

In statements published in 2021, both the European Society of Cardiology (ESC) and the American Heart Association (AHA) have called for better management of patients with obesity and CVD and for all such patients to be counselled on nutrition and physical activity and other targeted weight loss interventions, including weight loss medications.^1,2

In its most recent statement on obesity and CVD, its first update in 15 years, the American Heart Association (AHA) concludes that the treatment and management of patients with obesity and CVD needs to be improved.¹ The statement confirms obesity as a complex, multifactorial chronic disease linked to cardiovascular disease (CVD) and that a 10% or greater weight loss results in significant reductions in cardiovascular events.¹

The AHA has just updated its criteria for assessing cardiovascular health from the well-known ‘life’s simple 7’ to ‘life’s essential 8’. It now measures obesity as a risk factor for cardiovascular disease on par with high LDL cholesterol, hypertension and elevated blood glucose.⁸

Obesity is a risk factor for CVD on par with high LDL, blood pressure and blood sugar⁵

The European Society of Cardiology has also criticized the lack of priority given to weight loss in cardiovascular disease.  In a statement published in 2021, the ESC appealed for more help to be given to heart patients to lose weight.⁶ It cited a study of pooled data on 10,000 patients with CVD from the EUROASPIRE IV (2012 to 2013) and EUROASPIRE V (2016 to 2017) studies conducted in 29 European countries. Fewer than 20 percent of the patients had a healthy BMI at the time of their CVD event and more than a third of the patients with obesity said they had not received advice on physical activity or nutrition, with nearly one in five saying they had not been informed that they were overweight.⁶ The pooled data study found that 86 percent of patients with obesity did not lose weight following their event, and that 14 percent of patients who had overweight at the time of their event had obesity by the time of their 16-month follow up.⁷  The study authors concluded that obesity had “not been considered a serious medical problem requiring attention” in these patients.⁶

The potential for obesity management for secondary prevention of cardiac events in patients who have already been diagnosed with coronary heart disease was emphasised in the study.⁷ The authors recommended that cardiac rehabilitation programmes should specifically target weight loss interventions, including making use of telemedicine and appropriate weight loss medications.⁷

Click to read about obesity societies and their guidelines.

Evidence-based recommended interventions and therapies to reduce the risks of atherosclerotic cardiovascular disease (ASCVD) include medications to control hypertension, dyslipidaemia, diabetes and coagulation as well as lifestyle modifications. ^2,8

Source: Piepoli MF, Hoes A, Agewall S, et al. ² Patel K, Pandey A and de Lemos A.⁸

In spite of the evidence-based therapies to mitigate CVD mentioned above, individuals, especially those who have already experienced a cardiac event, still face residual risk for another CVD event.⁸

New drugs have recently been developed that target new pathophysiological pathways in CVD.⁸ Clinical trials have shown these can reduce event rates, and in some cases all-cause and cardiovascular mortality.⁸ Referring patients on to a cardiologist can allow them to be assessed for some of these medications.⁸

For more information on how to communicate risk in cardiovascular assessments, click here.