Presentation: Managing Cardiovascular Disease in People with Obesity
Over the past 4 decades, prevalence of obesity has increased rapidly at both the national and global level and exceeds 650 million representing a major public health challenge. Obesity is a major driver for both risk factors and many subtypes of cardiovascular disease, including hypertension, coronary heart disease, stroke, heart failure, and atrial fibrillation. In addition to shorter duration of healthy life, obesity is associated with shorter overall longevity and higher healthcare costs. Mechanisms linking obesity and cardiovascular disease include systemic inflammation, endothelial dysfunction, and sympathetic nervous system activation. Epidemiological studies of obesity in people with prevalent cardiovascular disease has raised a controversial finding of the “obesity paradox”, a epiphenomenon suggesting that obesity may be protective in individuals with clinical cardiovascular disease and leading to unclear messaging about the true health risks of excess weight. Individuals with Class III or greater obesity (body mass index greater than 40 kg/m2) may benefit from surgical approaches such as bariatric surgery, not only for weight loss, but also in terms of lower risk of cardiovascular disease, particularly heart failure. However, unique challenges in managing patients with obesity arise related to best practices for therapeutic management (e.g. direct acting oral anticoagulants) and limited studies of efficacy of novel treatments (e.g. neprilysin inhibitors in heart failure) as most people with severe obesity are excluded from randomized clinical trials. Efforts at preventing and optimally managing obesity is necessary to reverse the unfavorable trends in morbidity and mortality from cardiovascular disease related to obesity that have been observed worldwide.
Sadiya S. Khan, MD, MSc is a cardiologist at Northwestern Medicine and an assistant professor in the department of Medicine at Northwestern University Feinberg School of Medicine. Dr. Khan specializes in prevention of heart failure. Her research interests include understanding the influence of obesity on cardiovascular disease. She is an active member of the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America. She serves on multiple national committees focused on improving population and individual-level cardiovascular health.
Dr. Khan received her MD from Northwestern University Feinberg School of Medicine. She completed her postgraduate training at McGaw Medical Center of Northwestern. She is board certified in internal medicine and cardiovascular disease. Her bibliography includes over 70 peer-reviewed manuscripts, numerous book chapters, editorials, and review articles, including in high impact journals such as JAMA, Lancet, the BMJ, JACC, and Circulation. She is the recipient of the American Heart Association Women in Cardiology Award for Excellence, the American Heart Association Samuel A. Levine Young Investigator Award, and the Northwestern University Jameson Research Award.