Therapeutic Strategies for Obesity and Diabetes in Cardiovascular Disease Patients

Dear Colleagues,

Obesity and diabetes are significant risk factors for patients with cardiovascular diseases (CVDs), often exacerbating the severity and progression of the condition. Both obesity and diabetes contribute to the development of atherosclerosis, increasing the risk of heart attacks, strokes, and other cardiovascular events. In these patients, obesity typically leads to insulin resistance, which can worsen diabetes management and impact cardiovascular health.

Risk Factors:

1. Obesity: Excess body fat, particularly abdominal fat and possibly pericardial fat, leads to inflammation, increased blood pressure, and abnormal lipid levels, all of which are linked to higher cardiovascular risk. Obesity also promotes insulin resistance, making it more difficult for the body to regulate blood sugar.
2. Diabetes: Poorly controlled diabetes increases the risk of heart disease by promoting the accumulation of plaque in the arteries. Hyperglycemia contributes to endothelial dysfunction, inflammatory responses, and increased oxidative stress, all of which accelerate CVD progression.
3. Other Associated Risk Factors: Hypertension, high LDL cholesterol, smoke,  and a sedentary lifestyle often accompany obesity and diabetes, further elevating the risk of cardiovascular complications.

Treatment:

1. Lifestyle Modifications: Weight loss through diet and exercise is the cornerstone of managing obesity and diabetes in CVD patients. A balanced, low-calorie diet and regular physical activity can reduce risk factors, improve insulin sensitivity, and alleviate heart disease symptoms.
2. Pharmacological Treatments:

• Antidiabetic Medications: Drugs like metformin, GLP-1 receptor agonists, and SGLT-2 inhibitors not only control blood sugar levels but can also provide cardiovascular protection.
• Statins and Antihypertensives: Statins help control cholesterol levels, while antihypertensive medications can manage blood pressure, further reducing the cardiovascular burden.

3. Bariatric Surgery: In cases of severe obesity, bariatric surgery may be considered as an option to achieve significant weight loss, leading to improved diabetes control and reduced cardiovascular risk.
4. Regular Monitoring: Continuous monitoring of blood sugar, cholesterol levels, and blood pressure is essential to prevent complications in patients with obesity, diabetes, and CVD.

Dr. Davide D'Andrea
Guest Editor

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• obesity
• diabetes
• cardiovascular complications
• diabetes management
• pharmacological treatment
• bariatric surgery
• regular monitoring