Obesity, especially
visceral obesity, is associated with a cluster of metabolic complications increasing the risk of
type 2 diabetes and
coronary heart disease. It has been shown that obese patients characterized by a high accumulation of visceral adipose tissue have increased glycemic and insulinemic responses to an oral
glucose load compared to normal weight individuals or to obese individuals with a low accumulation of visceral adipose tissue. Viscerally obese patients are also characterized by an unfavourable plasma
lipid profile which includes elevated
triglyceride and
apolipoprotein B concentrations, reduced
HDL-cholesterol levels as well as an increased proportion of small, dense
LDL particles. Such alterations in the
lipid profile are often observed even in the absence of elevated
LDL-cholesterol concentrations. Our work has clearly shown that this cluster of metabolic abnormalities found among viscerally obese patients was associated with a substantial increase in
coronary heart disease risk. Our work has also shown that the "metabolic triad" of non-traditional risk factors (
hyperinsulinemia, elevated
apolipoprotein B levels, increased proportion of small, dense
LDL particles) was associated with a 20-fold increase in the risk of
coronary heart disease. In this regard, we have been interested in developing simple tools which would allow clinicians to identify at an early stage and at low cost individuals who would be carriers of the atherogenic metabolic triad. We have noted that the measurement and interpretation of waist circumference and of fasting plasma
triglyceride levels could allow the identification of a high proportion of carriers of the metabolic triad. Indeed, less than 10% of men with a waist circumference below 90 cm and
triglyceride concentrations below 2 mmol/l were characterized by the features of the metabolic triad. However, more than 80% of individuals with a waist circumference above 90 cm and
triglyceride levels above 2 mmol/l were carriers of the metabolic triad. Finally, an elevated visceral adipose tissue accumulation has also been associated with a thrombogenic and a pro-inflammatory metabolic profile which would be predictive of an unstable
atherosclerotic plaque. Therefore, the stabilisation of the
atherosclerotic plaque may represent a legitimate therapeutic objective to reduce the risk of
coronary heart disease among patients with
visceral obesity. It is proposed that a rather modest
weight loss (approximately 10%) could contribute to substantially improve the risk profile of these patients.