Section 2.3 Cardiovascular Complications

Key Points

  • Obesity is associated with increased cardiovascular risk
  • Weight loss by means of lifestyle therapy, pharmacotherapy, or bariatric surgery positively affects cardiovascular risk markers

AACE/ACE Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity Recommendations1

Dyslipidemia

  • R37. Patients with overweight or obesity and dyslipidemia (elevated triglycerides and reduced HDL-C) should be treated with lifestyle therapy to achieve 5% to 10% weight loss or more as needed to achieve therapeutic targets. The lifestyle intervention should include a physical activity program and a reduced-calorie healthy meal plan that minimizes sugars and refined carbohydrates, avoids trans fats, limits alcohol use, and emphasizes fiber.
  • R38. Patients with overweight or obesity and dyslipidemia should be considered for treatment with a weight-loss medication combined with lifestyle therapy when necessary to achieve sufficient improvements in lipids (i.e., elevated triglycerides and reduced HDL-C).

Hypertension

  • R39. Patients with overweight or obesity and elevated blood pressure or hypertension should be treated with lifestyle therapy to achieve 5% to 15% weight loss or more as necessary to achieve blood pressure reduction goals in a program that includes caloric restriction and regular physical activity.
  • R40. Patients with overweight or obesity and elevated blood pressure or hypertension should be considered for treatment with a weight-loss medication combined with lifestyle therapy when necessary to achieve sufficient weight loss for blood pressure reduction.
  • R41. Patients with hypertension considering bariatric surgery should be recommended for Roux-en-Y gastric bypass or sleeve gastrectomy, unless contraindicated, due to greater long-term weight reduction and better remission of hypertension than with laparoscopic adjustable gastric banding.
  • R92. Renin-angiotensin system inhibition therapy (angiotensin receptor blocker or angiotensin converting enzyme inhibitor) should be used as the first-line drug for blood pressure control in patients with obesity.
  • R93. Combination antihypertension therapy with calcium channel blockers may be considered as second-tier treatment. Beta blockers and thiazide diuretics may also be considered in some patients but can have adverse effects on metabolism; beta-blockers and alpha-blockers can promote weight gain.

Cardiovascular Disease (CVD)

  • R42. Weight-loss therapy is not recommended based on available data for the expressed and sole purpose of preventing CVD events or to extend life, although evidence suggests that the degree of weight loss achieved by bariatric surgery can reduce mortality. Cardiovascular outcome trials assessing medication-assisted weight loss are currently ongoing or being planned.
  • R43. Weight-loss therapy is not recommended based on available data for the expressed and sole purpose of preventing CVD events or to extend life in patients with diabetes. Cardiovascular outcome trials assessing medication-assisted weight loss are currently ongoing or being planned.

Congestive Heart Failure

  • R44. Weight-loss therapy is not recommended based on available data for the expressed purpose of preventing CVD events or to extend life in patients with congestive heart failure, although evidence suggests that weight loss can improve myocardial function and congestive heart failure symptomatology in the short term.

Reference

  1. Garvey WT, Mechanick JL, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients With Obesity. Endocr Pract. 2016;22(suppl 3);1-205.