The concept of cardiometabolic risk: Bridging the fields of diabetology and cardiology

Abstract

The lack of physical activity and the adoption of poor nutritional habits is the major cause of the obesity epidemic that is currently sweeping the world. The expansion of adipose tissue mass, especially of the visceral adipose tissue depot, is observed in the vast majority of individuals carrying the clinical features of the metabolic syndrome, an important (and reversible) risk factor of type 2 diabetes and cardiovascular disease. As waist circumference can be used as a crude estimate of visceral fat accumulation, its measurement provides further information on cardiovascular and type 2 diabetes risk, at any given body mass index value. However, an elevated waist circumference might also be the result of an increased ‘cardioprotective’ subcutaneous adipose tissue mass. We have proposed that the measurement of plasma triglycerides along with waist circumference, the so-called ‘hypertriglyceridemic waist’ might better quantify visceral obesity and its health hazards than waist circumference alone. “Hypertriglyceridemic waist” is thought to represent an altered, dysfunctional, and highly lipolytic adipose tissue that is a major culprit abnormality behind the metabolic syndrome and associated cardiometabolic risk, independently from classical cardiovascular disease risk factors such as age, sex, and plasma low-density lipoprotein (LDL) cholesterol levels.

• Cardiometabolic risk
• hypertriglyceridemic waist
• metabolic syndrome
• visceral adipose tissue

Acknowledgements

The work of the authors has been supported by research grants from the Canadian Institutes of Health Research, the Canadian Diabetes Association, the Heart and Stroke Foundation and by the Foundation of the Québec Heart Institute. Dr. Després is Scientific Director of the International Chair on Cardiometabolic Risk, which is supported by an unrestricted grant from Sanofi Aventis awarded to Université Laval. Benoit J. Arsenault is recipient of a training scholarship from Hôpital Laval Research Centre. Mélanie Côté is supported by a scholarship from the Fond de la recherche en santé du Québec. Amélie Cartier is supported by the training program in obesity which is supported by the Canadian Institutes of Health Research.