Complex Cardiometabolic Risk Factors: Impact, Assessment, and Emerging Therapies

Obesity now represents a worldwide public health concern. In the United States, two thirds of adults are overweight and one third are considered obese (body mass index ≥30 kg/m2). Visceral obesity, as a central component of the metabolic syndrome, contributes to an elevation in the risk for type 2 diabetes and cardiovascular disease, and, in turn, increased morbidity, mortality, and health care costs, especially in elderly populations. This manuscript examines the impact and current management of obesity and other aspects of the metabolic syndrome, as well as emerging treatment options, with a focus on the role of abnormalities in the endocannabinoid system. The foundation for this publication was a live symposium event at AMDA's national meeting in Dallas, Texas, March 16-19, 2006. The endocannabinoid receptor CB1 is involved in the regulation of energy balance and it has been identified in tissues related to the pathogenesis of obesity. Moreover, dysregulation of the endocannabinoid system is common in obese individuals. Further, recent clinical studies have shown that the novel, selective CB1 receptor antagonist rimonabant yields sustained reduction in weight and waist circumference, as well as improvements, independent of weight loss, in other aspects of the metabolic syndrome. Novel agents, such as rimonabant, that target fundamental pathogenic processes related to nutrient intake and fat storage, in conjunction with appropriate lifestyle changes, may efficiently treat obesity and related cardiometabolic disturbances.