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postgraduate thesis: Obesity and cardiovascular risks : a systematic review of current evidence

TitleObesity and cardiovascular risks : a systematic review of current evidence
Authors
Issue Date2017
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
Citation
Yuen, M. A. M. [袁美欣]. (2017). Obesity and cardiovascular risks : a systematic review of current evidence. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR.
AbstractIntroduction: Obesity is a growing global epidemic and its burden on the public health system is increasingly recognized. The population attributable risk of obesity in coronary heart disease in Hong Kong was quoted to be 9.2%. Recent data suggested an improved prognosis in overweight and obese patients with acute myocardial infarction and acute decompensated heart failure. The term “obesity paradox” was coined to describe this phenomenon. This review systematically evaluated current evidence and explored the relationship between obesity and cardiovascular disease. Methods: A systematic review of articles associating obesity with cardiovascular disease was performed. Total number of obesity-related cardiovascular disease was determined using a priori knowledge and a subsequent search of PubMed using medical subject headings (MeSH) and Boolean. Relevant articles for each individual cardiovascular disease were retrieved. The title and abstract of the retrieved articles were screened, and relevant articles were included for evaluation of quality using a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Qualitative analyses and meta-analyses were performed for cardiovascular conditions in which obesity paradox was observed. Results: A total of 12 obesity-related cardiovascular diseases was identified. One hundred and eight-six articles relevant to these 12 conditions were reviewed in detail and 147 articles were included for assignment to a GRADE-observational category. The condition with the greatest number of high quality articles (i.e. GRADE of 4) was incident heart failure (n=9), followed by hypertension (n=7), myocardial ischemia / coronary artery disease (n=6), atrial fibrillation and stroke (n=5 for both), angina pectoris and sudden cardiac death (n=2 for both) and left atrial enlargement (n=1). The best evidence was only of moderate quality (i.e. GRADE of 3) in left ventricular hypertrophy (n=2) and implantable cardioverter defibrillator complications (n=1). Only low quality evidence (i.e. GRADE 2) were available for both left ventricular dilatation (n=1) and diastolic dysfunction (n=3). Overall, obesity was associated with higher risk for all cardiovascular diseases. Mortality rates in heart failure, myocardial ischemia / coronary artery disease and stroke were lower in overweight and mildly obese individuals as compared to normal weight controls, but the relationship did not reach statistical significance on meta-analysis. Conclusions: This review of current evidence suggests that obesity is associated with increased risks for development of cardiovascular disease, but once the cardiovascular disease is established, there is some evidence to suggest better prognosis in association in higher BMI. Biological and statistical explanation for the “obesity paradox” was explored.
DegreeMaster of Public Health
SubjectObesity - Complications
Diseases - Risk factors - Cardiovascular system
Dept/ProgramPublic Health
Persistent Identifierhttp://hdl.handle.net/10722/252485

 

DC FieldValueLanguage
dc.contributor.authorYuen, Mae Ann Michele-
dc.contributor.author袁美欣-
dc.date.accessioned2018-04-23T07:44:37Z-
dc.date.available2018-04-23T07:44:37Z-
dc.date.issued2017-
dc.identifier.citationYuen, M. A. M. [袁美欣]. (2017). Obesity and cardiovascular risks : a systematic review of current evidence. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR.-
dc.identifier.urihttp://hdl.handle.net/10722/252485-
dc.description.abstractIntroduction: Obesity is a growing global epidemic and its burden on the public health system is increasingly recognized. The population attributable risk of obesity in coronary heart disease in Hong Kong was quoted to be 9.2%. Recent data suggested an improved prognosis in overweight and obese patients with acute myocardial infarction and acute decompensated heart failure. The term “obesity paradox” was coined to describe this phenomenon. This review systematically evaluated current evidence and explored the relationship between obesity and cardiovascular disease. Methods: A systematic review of articles associating obesity with cardiovascular disease was performed. Total number of obesity-related cardiovascular disease was determined using a priori knowledge and a subsequent search of PubMed using medical subject headings (MeSH) and Boolean. Relevant articles for each individual cardiovascular disease were retrieved. The title and abstract of the retrieved articles were screened, and relevant articles were included for evaluation of quality using a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Qualitative analyses and meta-analyses were performed for cardiovascular conditions in which obesity paradox was observed. Results: A total of 12 obesity-related cardiovascular diseases was identified. One hundred and eight-six articles relevant to these 12 conditions were reviewed in detail and 147 articles were included for assignment to a GRADE-observational category. The condition with the greatest number of high quality articles (i.e. GRADE of 4) was incident heart failure (n=9), followed by hypertension (n=7), myocardial ischemia / coronary artery disease (n=6), atrial fibrillation and stroke (n=5 for both), angina pectoris and sudden cardiac death (n=2 for both) and left atrial enlargement (n=1). The best evidence was only of moderate quality (i.e. GRADE of 3) in left ventricular hypertrophy (n=2) and implantable cardioverter defibrillator complications (n=1). Only low quality evidence (i.e. GRADE 2) were available for both left ventricular dilatation (n=1) and diastolic dysfunction (n=3). Overall, obesity was associated with higher risk for all cardiovascular diseases. Mortality rates in heart failure, myocardial ischemia / coronary artery disease and stroke were lower in overweight and mildly obese individuals as compared to normal weight controls, but the relationship did not reach statistical significance on meta-analysis. Conclusions: This review of current evidence suggests that obesity is associated with increased risks for development of cardiovascular disease, but once the cardiovascular disease is established, there is some evidence to suggest better prognosis in association in higher BMI. Biological and statistical explanation for the “obesity paradox” was explored. -
dc.languageeng-
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)-
dc.relation.ispartofHKU Theses Online (HKUTO)-
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subject.lcshObesity - Complications-
dc.subject.lcshDiseases - Risk factors - Cardiovascular system-
dc.titleObesity and cardiovascular risks : a systematic review of current evidence-
dc.typePG_Thesis-
dc.description.thesisnameMaster of Public Health-
dc.description.thesislevelMaster-
dc.description.thesisdisciplinePublic Health-
dc.description.naturepublished_or_final_version-
dc.date.hkucongregation2017-
dc.identifier.mmsid991043984188803414-

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