Abdominal Obesity, Dyslipidemia, Insulin Resistance, Type 2 Diabetes and Atherosclerosis: Who Is the Right Patient to Be Treated with Cb1 Receptor Antagonists?

Introduction The health hazards of abdominal obesity were documented several decades ago when, in 1947, a French physician by the name of Dr. Jean Vague published in Presse Médicale the results of his clinical observations on the “android” type of obesity (“apple shape”) [1]. Vague was the first to suggest that android obesity was the high-risk form of obesity. In contrast, he proposed that “gynoid” obesity (often found in women) was rather benign [1]. Thus, Vague was the first to foresee the importance of upper body, abdominal obesity as a phenotype frequently observed in individuals with cardiovascular disease, type 2 diabetes and hypertension. Results from epidemiological studies that began to be published in the early eighties confirmed the increased risk of adverse cardiovascular outcomes associated with such a form of overweight/obesity. Most of these studies assessed the absolute or relative amount of abdominal fat using crude anthropometric indices such as waist circumference or the waist-to-hip circumference ratio [2-6]. Very recently, the importance of abdominal obesity beyond overall general adiposity as a risk factor for total mortality has been confirmed in the largest prospective study ever conducted on the topic. Results of the EPIC Key Points