Philippe-Gabriel Steg
Department of Cardiology, Hôpital Bichat, Paris, France

There is currently a worldwide epidemic of obesity, with childhood and adult obesity rising rapidly. This phenomenon, although presently more prevalent in North America, is also spreading fast to other parts of the world. The epidemic appears related largely to a combination of sedentary lifestyle and dietary inadequacies, with excessive intake of energy-dense food. In addition, evidence links obesity to a rise in all-cause and cardiovascular mortality. This is probably one of the reasons why cardiovascular disease is still the first cause of mortality worldwide, despite a steady decline in the West, and even more importantly, why it is expected to stay in the lead twenty years from now. Moreover, not only is obesity spreading, but at the same time the prevalence of diabetes mellitus, with the associated greater risk of cardiovascular events, is increasing rapidly on a global scale.

Of even greater relevance is the impact of obesity on cardiovascular risk, and specifically the direct linkage of the latter with abdominal obesity. A large body of data demonstrates today the key role of abdominal fat in inflammation, lipid and glycaemic abnormalities, and ultimately the cardiovascular risk associated with the Metabolic Syndrome. Because Metabolic Syndrome is associated with higher cardiovascular risk and a dramatically higher risk of diabetes, its recognition has become a major issue in preventive cardiology. As a result, Metabolic Syndrome and, more generally, abdominal obesity are becoming more recognisable cardiovascular health problems, and clinicians in charge of cardiac patients must be trained in how to detect, recognise, and address these issues. Overall, secondary prevention of cardiovascular disease with pharmacological agents has been extraordinarily successful in decreasing cardiovascular risk: antiplatelet agents, hypolipidaemic agents, and antihypertensive agents are all now part of the standard armamentarium of cardiovascular care. In contrast, achieving long-term lifestyle modifications remains very difficult. It is therefore important to integrate pharmacological therapies into disease management strategies, which should include patient education, exercise programmes, and dietary advice. In particular, exercise appears to be one of the most important and effective therapies to both prevent and treat Metabolic Syndrome before cardiovascular events occur. One of the important challenges in research and education will be to link primary-care physicians and the various specialities involved in caring for these patients in order to cope with the upcoming epidemic. Cardiologists are awakening to the call and taking great interest in this important topic.