Let’s Talk About Obesity And Cardiovascular Disease — Dr Yap Jun Fai, Prof Dr Moy Foong Ming & Dr Lim Yin Cheng

Since Malaysia is currently ranked as the most obese country in Southeast Asia, it is vital to raise public awareness about this global health issue, particularly in the context of cardiovascular disease.

Cardiovascular disease (CVD) is an umbrella term for several medical disorders affecting the heart or blood vessels. CVD tends to happen among the at-risk individuals.

In fact, obesity (defined as body mass index over 30 kg/m2) is a well-recognised risk factor for CVD in both men and women.

Though obesity is a relatively common health condition, it is often inadequately addressed by both health care workers and patients. For instance, only one in 10 overweight (defined as body mass index of 25.0 kg/m2 to 30 kg/m2) or obese patients told to reduce weight actually sought help from a health care worker in the United States.

Since Malaysia is currently ranked as the most obese country in Southeast Asia, it is vital to raise public awareness about this global health issue, particularly in the context of CVD.

There are many examples of CVD, but the rarer spectrum of CVD affecting obese individuals are venous thromboembolism (VTE) and peripheral arterial disease (PAD).

VTE is the third most frequent cause of death from CVD (after heart attack and stroke). Characterised by blood clot formation in the veins (blood vessels carrying oxygen-depleted blood), VTE encompasses two interrelated pathologies, namely deep vein thrombosis (DVT) and pulmonary embolism (PE).

DVT typically develops in the non-superficial veins of the lower leg, thigh, pelvis, and sometimes arm. In general, several non-specific symptoms of DVT such as sudden swelling of the involved body area associated with localised pain and skin redness may require further confirmative tests in the hospital.

If a part of the DVT clot dislodges and travels via the blood circulation to the lungs causing significant pulmonary mainstream obstruction, PE would ensue, leading to chest pain, shortness of breath, coughing up of blood, irregular heartbeat, or even death (due to resulting right-sided cardiac failure or cardiac arrest). 

On the other hand, PAD occurs when arteries (blood vessels transporting oxygen-rich blood) of the arms, legs or feet become stiff and narrow secondary to buildup of fatty materials along the arterial wall. Hallmark features of PAD may manifest as acute limb ischemia, which are classically described as any of the six Ps (pain, pale, poikilothermia, pulselessness, paresthesia, or paralysis).

If left untreated, one of the most dreadful complications of PAD is critical limb ischemia. This progressive condition is illustrated by severe blockage of the lower extremities’ arteries causing markedly reduced blood flow or tissue loss in the forms of non-healing ulcers or gangrene. Amputation of the affected limb region may be warranted at the most extreme case. 

Obesity is linked with CVD, as it induces prolonged inflammation and impairs the inherent process of breaking down blood clots in the body circulation.

Fortunately, losing substantial body weight among obese individuals or maintaining a healthy weight can largely reduce lifetime risk of CVD.

Recognising early signs and symptoms of VTE or PAD is also potentially lifesaving as targeted medical treatment can be administered promptly. 

In line with World Obesity Day 2023’s theme of ‘Changing perspectives: Let’s talk about obesity’, we should continue to share health facts about obesity and its many adverse cardiovascular consequences.

We hope that obesity can be diagnosed and managed early with relevant incorporation of comprehensive lifestyle intervention or medical treatment (drug therapy, devices, bariatric surgery), to prevent an established CVD from happening. 

Dr Yap Jun Fai, Prof Dr Moy Foong Ming and Dr Lim Yin Cheng are from the Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya and the Department of Public Health, University Malaya Medical Centre. 

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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