UH Harrington Heart & Vascular Institute Cardiologist Co-Authors AHA Scientific Statement on Obesity and Cardiovascular Disease

Innovations in Cardiovascular Medicine & Surgery | Summer 2021

More than 3 billion people worldwide are overweight or obese, according to the American Heart Association (AHA). Yet as the global obesity epidemic escalates, experts are finding that excess fat is not one-size-fits-all when it comes to cardiovascular disease (CVD) risk. Visceral adipose tissue surrounds vital internal organs and may pose greater risk than fat deposits elsewhere in the body, even for normal-weight individuals.

In their flagship journal Circulation, the AHA recently released a scientific statement on obesity and CVD¹ that addresses its impact on the pathophysiology, diagnosis and treatment of atherosclerotic CVD, heart failure and arrhythmias. Of significance, the statement identifies abdominal obesity as a CVD marker that is independent of body mass index (BMI).

“Visceral adiposity and liver fat are important markers of cardiovascular disease risk,” says Ian J. Neeland, MD, FAHA, FACC, who was one of the authors of the AHA statement.

Dr. Neeland is Director of the Center for Cardiovascular Prevention and Co-Director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) within University Hospitals Harrington Heart & Vascular Institute. A member of the Obesity Committee of the AHA, he also serves on the American College of Cardiology (ACC) Board Review for Prevention and authored the obesity module for physicians seeking CVD recertification.

Advancing diagnosis and treatment

Evaluating coronary artery disease (CAD) is often complicated by obesity, including inconclusive electrocardiogram [ECG] results and cardiopulmonary limitations on patients' maximum exercise capacity. At University Hospitals, board-certified cardiologists within the Center for Cardiovascular Prevention are reimagining CVD prevention through personalized risk assessment and advanced diagnostic testing, including:

• Coronary artery calcium (CAC) scoring
• Coronary angiography
• MRI/CMRI/CT imaging
• Stress/pharmacological stress echocardiography
• Cardiopulmonary exercise testing
• Nuclear medicine

Innovative imaging modalities are also creating new pathways to study body composition. "There is significant variation in where pockets of fat accumulate in the body,” Dr. Neeland says. “Using the most precise and accurate imaging techniques available, we can tease apart different fat deposits that contribute to CVD and target therapies that may reduce risk and improve outcomes.”

He and fellow researchers at UH are utilizing body fat imaging data to fuel novel research initiatives. They have submitted several grants, including one to the National Institutes of Health comparing body fat imaging through MRI to standard BMI data and its potential to impact risk perception, behavior change and clinical outcomes.

“At UH, we are reshaping CVD prevention,” Dr. Neeland says. “Combining our clinical programs with translational research informs and enables us to take better care of patients using the most up-to-date technologies and concepts."

Multispecialty UH programs address individual needs

• CINEMA provides integrated, holistic care for patients with metabolic disorders and related cardiac complications. The novel program is under the leadership of Founding Director Sanjay Rajagopalan, MD, Chief of the Division of Cardiovascular Medicine at UH Harrington Heart & Vascular Institute and Professor at School of Medicine; Co-Director Sadeer Al-Kindi, MD, a cardiologist at UH Harrington Heart & Vascular Institute and Associate Professor at School of Medicine, and Dr. Neeland.
• Fitter Me offers a comprehensive approach to weight loss, including nutritional and behavioral counseling, along with bariatric, non-surgical and medication-assisted options. The program is directed by Goutham Rao, MD, Division Chief of Family Medicine at UH Rainbow Babies and Children's Hospital, Chair of the Department of Family Medicine and Community Health at UH Cleveland Medical Center and a Clinical Professor at School of Medicine.
• The Diabetes and Metabolic Care Center offers comprehensive diabetes care and education while fostering multispecialty integrative care and research across the UH community. The center is directed by Betul Hatipoglu, MD
• CAC scoring, via a noninvasive, low-dose CT scan, is offered to patients with specific cardiovascular and inflammatory risk factors. Perhaps the only program of its kind worldwide, the screening is available at no-cost through substantial investment in preventive healthcare by UH.

"Social determinants of health and equitable access to nutritional food sources are also significant factors in the obesity epidemic. UH is at the center of a highly diverse community. We serve patients from all walks of life and offer a wealth of opportunities to treat obesity, along with all of its complications," says Dr. Neeland. "If we can create a heightened understanding of how excess weight affects heart disease, kidney disease and diabetes, we can hopefully reduce the rates of obesity and the associated burden on our healthcare system."

For more information, please contact Dr. Neeland at 216-844-5965 or Ian.Neeland@UHhospitals.org.

1. Tiffany M. Powell-Wiley, MD, MPH, FAHA, Chair, Paul Poirier, MD, PhD, FAHA, Vice Chair, Lora E. Burke, PhD, MPH, FAHA, Jean-Pierre Després, PhD, FAHA, Penny Gordon-Larsen, PhD, FAHA, Carl J. Lavie, MD, Scott A. Lear, PhD, FAHA, Chiadi E. Ndumele, MD, PhD, FAHA, Ian J. Neeland, MD, FAHA, Prashanthan Sanders, MBBS (Hons), PhD, FAHA, Marie-Pierre St-Onge, PhD, FAHA, On behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council. Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2021;143:00–00. doi: 10.1161/CIR.0000000000000973

contributing Expert:

Ian Neeland, MD
Director, Cardiovascular Prevention
Co-Director, Center for Integrated and Novel Approaches in Vascular-Metabolic Disease
UH Harrington Heart & Vascular Institute
Associate Professor
Case Western Reserve University School of Medicine