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Diabesity: the combined burden of obesity and diabetes on heart disease and the role of imaging

Nature Reviews Cardiology volume 18, pages 291–304 (2021)Cite this article

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Abstract

Diabesity is a term used to describe the combined adverse health effects of obesity and diabetes mellitus. The worldwide dual epidemic of obesity and type 2 diabetes is an important public health issue. Projections estimate a sixfold increase in the number of adults with obesity in 40 years and an increase in the number of individuals with diabetes to 642 million by 2040. Increased adiposity is the strongest risk factor for developing diabetes. Early detection of the effects of diabesity on the cardiovascular system would enable the optimal implementation of effective therapies that prevent atherosclerosis progression, cardiac remodelling, and the resulting ischaemic heart disease and heart failure. Beyond conventional imaging techniques, such as echocardiography, CT and cardiac magnetic resonance, novel post-processing tools and techniques provide information on the biological processes that underlie metabolic heart disease. In this Review, we summarize the effects of obesity and diabetes on myocardial structure and function and illustrate the use of state-of-the-art multimodality cardiac imaging to elucidate the pathophysiology of myocardial dysfunction, prognosticate long-term clinical outcomes and potentially guide treatment strategies.

Key points

  • Diabesity describes the combined detrimental health effects of obesity and diabetes mellitus.

  • Early detection of the effects of diabesity on the cardiovascular system would enable the optimal implementation of effective therapies to prevent ischaemic heart disease and heart failure.

  • Advanced imaging techniques have helped us to understand how diabesity leads to atherosclerosis and cardiac remodelling and dysfunction.

  • Advanced imaging techniques have improved our understanding of how various therapies can halt or reverse the atherosclerotic and cardiac remodelling processes.

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Fig. 1: Obesity trends in adults and children in the USA.
Fig. 2: Myocardial substrate metabolism.
Fig. 3: Quantification of cardiac energetics.
Fig. 4: Quantification of myocardial fat.
Fig. 5: Quantification of epicardial fat volume.
Fig. 6: Assessment of cardiac sympathetic innervation.
Fig. 7: Quantification of interstitial fibrosis.

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Authors and Affiliations

  1. Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Arnold C. T. Ng

  2. Translational Research Institute, Brisbane, Queensland, Australia

    Arnold C. T. Ng

  3. The University of New South Wales, Sydney, New South Wales, Australia

    Arnold C. T. Ng

  4. Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands

    Victoria Delgado & Jeroen J. Bax

  5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Barry A. Borlaug

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A.C.T.N., B.A.B. and J.J.B. researched data for the article. All the authors provided substantial contribution to the discussion of its content, wrote the manuscript, and reviewed and edited it before submission.

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Competing interests

V.D. and J.J.B. received speaker fees from Abbott Vascular and Edwards Lifesciences. B.A.B. receives support from the NIH (R01 HL128526). The Department of Cardiology of the Leiden University Medical Centre receives unrestricted research grants from Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. A.C.T.N. declares no competing interests.

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Ng, A.C.T., Delgado, V., Borlaug, B.A. et al. Diabesity: the combined burden of obesity and diabetes on heart disease and the role of imaging. Nat Rev Cardiol 18, 291–304 (2021). https://doi.org/10.1038/s41569-020-00465-5

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