Obesity and Cardiovascular Risk in Type 2 Diabetes
Summary
Obesity and type 2 diabetes mellitus often coexist, creating a synergistic burden on cardiovascular health. Excess adiposity contributes directly to insulin resistance, dyslipidaemia and hypertension, while also driving chronic inflammation and endothelial dysfunction. These mechanisms accelerate atherosclerosis and heighten the risk of myocardial infarction, stroke and heart failure in people with diabetes. Paradoxically, observational studies have sometimes reported lower all-cause mortality among overweight or mildly obese individuals with type 2 diabetes compared with their leaner counterparts, a phenomenon referred to as the “obesity paradox”. However, this apparent protective effect is tempered by evidence that, beyond a certain threshold of adiposity, cardiovascular risk increases markedly. Global trends indicate rising prevalence of obesity among people with diabetes in both high-income and low- and middle-income regions, underscoring the need for integrated strategies that address weight management alongside glycaemic, lipid and blood pressure control. Lifestyle modification, pharmacotherapy and bariatric surgery have all demonstrated benefits in reducing cardiovascular events, yet optimal treatment pathways must be tailored to individual risk profiles, comorbidities and health-care settings.
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Obesity and Cardiovascular Risk in Type 2 Diabetes publication trend
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Technical terms
Body mass index (BMI): A measure of body fat based on weight in kilograms divided by height in metres squared, used to classify underweight, normal weight, overweight and obesity.
Obesity paradox: The counterintuitive observation that mildly obese individuals with certain chronic diseases, including type 2 diabetes, may exhibit lower short-term mortality than leaner counterparts.
Endothelial dysfunction: Impaired function of the inner lining of blood vessels, contributing to atherosclerosis and thrombosis.
Insulin resistance: A state in which cells respond poorly to insulin, leading to elevated blood glucose and compensatory hyperinsulinaemia.
Major adverse cardiovascular events (MACE): A composite endpoint commonly including cardiovascular death, myocardial infarction and stroke.
References
- Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies. Diabetologia (2016).
- Obesity and glycemic control among people with type 2 diabetes in the United States: A retrospective cohort study using insurance claims data. Journal of Diabetes and its Complications (2021).
- Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity paradox in a Korean national cohort study. Cardiovascular Diabetology (2020).
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