Obesity and Cardiovascular Disease in Women

Obesity is a serious chronic condition of epidemic proportions, increasing incidence of cardiovascular (CV) disease (CVD) and other morbid conditions. Women are particularly affected by the obesity epidemic. The greater prevalence of obesity in women becomes only manifested in adulthood, with peak prevalence occurring between 60 and 64 years of age. The sex-related difference in obesity prevalence have been attributed to nutrition, lifestyle, behavior, and environment. The association of CVD and obesity is particularly relevant in women, being their leading cause of death. Nondiabetic premenopausal women are protected against CVD when compared with age-matched men. However, once obese and insulin resistant, women exhibit worsened CVD outcomes. The increased CV risk in obese women is largely due to coexistence with diabetes, hyperlipidemia, and hypertension. Since overweight and obesity are associated with increased prevalence of CV risk factors and incidence of CVD events, weight loss in obese women is expected both to benefit long-term survival and to have many beneficial effects on CV risk factors. Therapy for obesity is based on lifestyle changes, drugs, and bariatric surgery. Lifestyle modifications include low calorie diets and moderate-intensity physical activity. The most effective weight reducing drugs are GLP-1 (glucagon-like peptide-1) receptor agonists, which can induce a weight loss greater than 10% in most individuals, more pronounced in females. Metabolic surgery can induce an average weight loss of up to 20% for as much as 20 years. Matched-pair cohort analysis demonstrated that bariatric surgery results in comparable short- and mid-term efficacy in men and women.