The Concept of CMR

The diabesity epidemic: a growing burden

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Among well-established cardiovascular risk factors, obesity and diabetes are on the rise (1, 2). The coronary heart disease mortality risk of diabetic patients without previous cardiovascular complications has been shown to be similar to that of nondiabetic patients who previously had a myocardial infarction (3). This suggests that cardiovascular risk factors and complications should be treated aggressively in diabetic patients, who should be seen as post-myocardial infarction patients from a global cardiovascular disease risk standpoint (3). Moreover, obesity—abdominal obesity in particular—is one of the major risk factors for diabetes along with physical inactivity and family history (3, 4). To illustrate the consequences of obesity, Allison et al. (5) used data from five large cohort studies to estimate annual obesity-related deaths among U.S. adults. They estimated that obesity was a factor in approximately 280,000 deaths per year and that more than 80% of these deaths occurred among persons with a body mass index (BMI) superior to 30 kg/m².

Shafrir (6) coined the term “diabesity” 10 years ago to illustrate the close relationship between obesity and diabetes. Both diseases share common causes, including lack of exercise and low energy expenditure combined with an unhealthy diet high in fat and refined sugar. The increasing prevalence of obesity and diabetes worldwide is a major public health threat and fighting this two-pronged epidemic will certainly be one of the biggest challenges for health professionals and our society in coming decades. This epidemic is expected to have serious health and economic consequences as obesity and diabetes rates continue to soar (7). Obese and diabetic patients are more likely to be hospitalized for cardiovascular complications and other diabetes-related problems, such as microvascular complications, than normal weight, nondiabetic individuals.

Reference

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1. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006; 295: 1549-55.

2. Zimmet P, Alberti KG and Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001; 414: 782-7.

3. Haffner SM. Epidemiology of type 2 diabetes: risk factors. Diabetes Care 1998; 21 Suppl 3: C3-6.

4. Ekelund U, Griffin SJ and Wareham NJ. Physical activity and metabolic risk in individuals with a family history of type 2 diabetes. Diabetes Care 2007; 30: 337-42.

5. Allison DB, Fontaine KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA 1999; 282: 1530-8.

6. Shafrir E. Development and consequences of insulin resistance: lessons from animals with hyperinsulinaemia. Diabetes Metab 1996; 22: 122-31.

7. Smyth S and Heron A. Diabetes and obesity: the twin epidemics. Nat Med 2006; 12: 75-80.

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