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Obesity and cardiovascular risk: a call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity part A mechanisms of obesity induced hypertension, diabetes and dyslipidemia and practice guidelines for treatment

Kotsis, Vasiliosa; Jordan, Jensb; Micic, Draganc; Finer, Nicholasd; Leitner, Deborah, R.e; Toplak, Hermanne; Tokgozoglu, Lalef; Athyros, Vasiliosg; Elisaf, Mosesh; Filippatos, Theodosios, D.i; Redon, Josepj,k; Redon, Pauj; Antza, Christinaa; Tsioufis, Konstantinosl; Grassi, Guidom,n; Seravalle, Ginoo; Coca, Antoniop; Sierra, Cristinap; Lurbe, Emparq,r; Stabouli, Stellas; Jelakovic, Bojant; Nilsson, Peter, M.u

doi: 10.1097/HJH.0000000000001730

Obesity is a key factor for cardiovascular diseases and complications. Obesity is associated with hypertension, dyslipidemia and type II diabetes, which are the major predictors of cardiovascular disease in the future. It predisposes for atrial fibrillation, heart failure, sudden cardiac death, renal disease and ischemic stroke that are the main causes of cardiovascular hospitalization and mortality. As obesity and the cardiovascular effects on the vessels and the heart start early in life, even from childhood, it is important for health policies to prevent obesity very early before the disease manifestation emerge. Key roles in the prevention are strategies to increase physical exercise, reduce body weight and to prevent or treat hypertension, lipids disorders and diabetes earlier and efficiently to prevent cardiovascular complications.

Epidemiology and mechanisms of obesity-induced hypertension, diabetes and dyslipidemia will be reviewed and the role of lifestyle modification and treatment strategies in obesity will be updated and analyzed. The best treatment options for people with obesity, hypertension, diabetes and dyslipidemia will discussed.

a3rd Department of Internal Medicine, Hypertension-24 h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece

bInstitute for Clinical Pharmacology, Medical School Hannover, Hannover, Germany

cCenter for Obesity, Clinic for Endocrinology, Diabetes and Diseases of Metabolism Clinical Center of Serbia, Serbia

dNational Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UK

eDepartment of Medicine, Medical University Graz, Graz, Austria

fDepartment of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey

gSecond Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki

hDepartment of Internal Medicine, School of Medicine, University of Ioannina, Ioannina

iDepartment of Internal Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece

jINCLIVA Research Institute, University of Valencia, Valencia

kCIBERObn (CB06/03), Instituto de Salud Carlos III, Madrid, Spain

lFirst Cardiology Clinic, Medical School, National and Kapodistrian University of Athens Hippokration Hospital, Athens, Greece

mClinica Medica,School of Medicine and Surgery, Milano-Bicocca University

nIRCCS, Multimedica Sesto San Giovanni

oCardiology Department Istituto Auxologico Italiano, S. Luca Hospital, Milan, Italy

pHypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic of Barcelona (IDIBAPS), University of Barcelona

qPediatric Department, Consorcio Hospital General, University of Valencia, Valencia

rCIBERObn (CB06/03) Instituto de Salud Carlos III, Madrid, Spain

s1st Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

tDepartment of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb,Croatia

uDepartment of Internal Medicine, Skåne University Hospital, Malmö, Sweden

Correspondence to Professor Vasilios Kotsis, MD, PhD, Hypertension-ABPM Center, Papageorgiou Hospital, Chairman, Working Group on Obesity, Diabetes and the High-risk Patients, 39 Zaka, Panorama 55236, Thessaloniki, Greece. Tel: +30 6974748860; fax: +30 2310452429; e-mail:

Abbreviations: β-blockers, beta blockers; ACE, angiotensin-converting enzyme; ARBs, angiotensin receptor blockers; BP, blood pressure; CCBs, calcium channel blockers; CETP, cholesteryl ester transfer protein; CRF, cardiorespiratory fitness; CRP, C-reactive protein; DAG, diacylglyceride; DPP-IV, dipeptidyl peptidase-IV; FFAs, free-fatty acids; GLP1, glucagon-like peptide 1; HBA1c, hemoglobin A1c; HDL, high-density lipoprotein; IKK, IκB kinase; IL-1, interleukin-1β; IL-6, interleukin-6; JNK, c-JUN N-terminal kinase; LDL, low-density lipoprotein; LPL, lipoprotein lipase; MCP-1, macrophage chemoattractant protein-1; NAFLD, nonalcoholic fatty liver disease; NF-Kb, nuclear factor-κB; NO, nitric oxide; OSA, obstructive sleep apnea; PCSK9, proprotein convertase subtilisin/kexin type 9; PPARγ, peroxisome proliferator-activated receptor gamma; PRA, plasma renin activity; RAS, renin–angiotensin system; SGLT2, sodium-glucose co-transporter 2; SNS, sympathetic nervous system; TNF-a, tumor necrosis factor-α; VEGF, vascular endothelial growth factor; VLDL, very low-density lipoprotein

Received 8 February, 2018

Revised 18 February, 2018

Accepted 23 February, 2018

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