Obesity is becoming a global epidemic in both children and adults. It is associated with numerous comorbidities such as cardiovascular diseases (CVD), type 2 diabetes, hypertension, certain cancers, and sleep apnea/sleep-disordered breathing. In fact, obesity is an independent risk factor for CVD, and CVD risks have also been documented in obese children. Obesity is associated with an increased risk of morbidity and mortality as well as reduced life expectancy. Health service use and medical costs associated with obesity and related diseases have risen dramatically and are expected to continue to rise. Besides an altered metabolic profile, a variety of adaptations/alterations in cardiac structure and function occur in the individual as adipose tissue accumulates in excess amounts, even in the absence of comorbidities. Hence, obesity may affect the heart through its influence on known risk factors such as dyslipidemia, hypertension, glucose intolerance, inflammatory markers, obstructive sleep apnea/hypoventilation, and the prothrombotic state, in addition to as-yet-unrecognized mechanisms. On the whole, overweight and obesity predispose to or are associated with numerous cardiac complications such as coronary heart disease, heart failure, and sudden death because of their impact on the cardiovascular system. The pathophysiology of these entities that are linked to obesity will be discussed. However, the cardiovascular clinical evaluation of obese patients may be limited because of the morphology of the individual. In this statement, we review the available evidence of the impact of obesity on CVD with emphasis on the evaluation of cardiac structure and function in obese patients and the effect of weight loss on the cardiovascular system.

/pdf/obesity-and-cardiovascular-disease-pathophysiology-3oufiofv6y.pdf

Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss

The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations

https://www.ahajournals.org/doi/pdf/10.1161/01.str.0000199147.30016.74?ijkey=567b368d4e69985fc2c1c99723b3d8de8e39c28a

Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic Attack : A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke : Co-sponsored by the Council on Cardiovascular Radiology and Intervention : The American Academy of Neurology affirms the value of this guideline

The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations.

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack

The Joint British Societies’ guidelines (JBS 2) on cardiovascular disease prevention in clinical practice were developed by a Working Party (see table) with nominated representatives from six professional societies. All members contributed to the text and those from the specialist societies of hypertension, lipids, and diabetes were specifically responsible for developing the sections on blood pressure, lipids, and glucose. All sections of the document represent an evidence based consensus by all professional societies involved. The scientific literature which informs the recommendations is referenced throughout the text and Dr Kornelia Kotseva is thanked for all her help in searches for systematic reviews and meta-analyses, and checking the referencing of all sections. We are grateful to both Mr Harry Heyes of the Department of Medical Illustration, University of Manchester, for the cardiovascular risk prediction charts artwork, and Mr Daniel Prais of Crawford’s Business Services, Salford, for the computer programming. Dr Paola Primatesta is thanked for providing prevalence estimates of total CVD risk in the adult population from the Health Survey for England. Mr Tim Collier (Statistician, London School of Hygiene and Tropical Medicine) is also thanked for preparing the figures on lipid trials. Despoina Xenikaki provided the Working Party with invaluable administrative support. This guideline was reviewed and approved by the boards of all the professional societies. 

View this table:

JBS 2 Working Party 



### SUMMARY

The aim of these new Joint British Societies’ guidelines (JBS 2) developed by the British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, and The Stroke Association is to promote a consistent multidisciplinary approach to the management of people with established atherosclerotic cardiovascular disease (CVD) and those at high risk of developing symptomatic atherosclerotic disease.

We recommend that CVD prevention in clinical practice should focus equally on (i) people with established atherosclerotic CVD, (ii) people with …

https://heart.bmj.com/content/heartjnl/91/suppl_5/v1.full.pdf

JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice

Objective. —To examine the associations of body mass index (BMI) and weight change with risk of stroke in women. Setting and Design. —Prospective cohort study among US female registered nurses participating in the Nurses' Health Study. Participants. —A total of 116 759 women aged 30 to 55 years in 1976 who were free from diagnosed coronary heart disease, stroke, and cancer. Main Outcome Measure. —Incidence of ischemic stroke, hemorrhagic stroke (subarachnoid or intraparenchymal hemorrhage), and total stroke. Results. —During 16 years of follow-up, 866 total strokes (including 403 ischemic strokes and 269 hemorrhagic strokes) were documented. In multivariate analyses adjusted for age, smoking, postmenopausal hormone use, and menopausal status, women with increased BMI (≥27 kg/m 2 ) had significantly increased risk of ischemic stroke, with relative risks (RRs) of 1.75 (95% confidence interval [CI], 1.17-2.59) for BMI of 27 to 28.9 kg/m 2 ; 1.90 (95% CI, 1.28-2.82) for BMI of 29 to 31.9 kg/m 2 ; and 2.37 (95% CI, 1.60-3.50) for BMI of 32 kg/m 2 or more ( P for trend 2 . For hemorrhagic stroke there was a nonsignificant inverse relation between obesity and hemorrhagic stroke, with the highest risk among women in the leanest BMI category ( P for trend=.20). For total stroke the RRs were somewhat attenuated compared with those for ischemic stroke but remained elevated for women with higher BMI ( P for trend P for trend P for trend=.20), a direct relationship was observed between weight gain and total stroke risk ( P for trend Conclusions. —These prospective data indicate that both obesity and weight gain in women are important risk factors for ischemic and total stroke but not hemorrhagic stroke. The relationship between obesity and total stroke depends on the distribution of stroke subtypes in the population.

https://jamanetwork.com/journals/jama/articlepdf/416249/jama_277_19_032.pdf

A Prospective Study of Body Mass Index, Weight Change, and Risk of Stroke in Women

While evidence suggests that obesity has an independent relation to coronary artery disease, similar findings for stroke have not been established. The purpose of this study was to examine the relation between body mass index and the risk of thromboembolic stroke independently of other risk factors.Since 1965, the Honolulu Heart Program has followed a cohort of men in a prospective study of cardiovascular disease. This article examines the relationship between the baseline measurement of body mass index and the risk of thromboembolic stroke in 1163 nonsmoking men in older middle age (55 to 68 years). Men who had an elevated risk of stroke due to hypertension, diabetes, and other risk factors were excluded from the analysis.After 22 years of follow-up, the rate of stroke increased significantly with increasing levels of body mass (P < .01). In the bottom tertile of the body mass index, the rate of thromboembolic stroke was 28.7 per 1000 (11/383). In the middle tertile, the rate was increased by 40% to 40.7...

https://www.ahajournals.org/doi/pdf/10.1161/01.STR.25.12.2370

D S Sharp

Papers

Body mass index and thromboembolic stroke in nonsmoking men in older middle age. The Honolulu Heart Program.