CONTENTS

Abstract .................................................................................................................................. 2 Introduction ............................................................................................................................ 3 Obesity ................................................................................................................................... 3 Dyslipidemia .......................................................................................................................... 3 Hypertension .......................................................................................................................... 4 Discussion .............................................................................................................................. 4 Conclusion ............................................................................................................................. 7 References .............................................................................................................................. 8

Abstract Obesity is one of public health problems that is important and growing rapidly nowadays around the world. It varies by age and sex, and by race-ethnic group. In the United States, approximately one third of adults are obese and the prevalence of overweight and obesity in the pediatric population has increased substantially. Obesity adversely affects the major cardiovascular risk factors. The risk factors are dyslipidemia, hypertension, and type 2 diabetes mellitus. It also increased incidence of other conditions of non cardiovascular such as non alcoholic fatty liver disease, rheumatoid arthritis, and with an increased risk of disability. As a consequence, obese persons have an increased risk of death, especially from cardiovascular disease. Evidence suggests that hypertension may share pathophysiology with cardiovascular disease. Thus, dyslipidemia, a strong predictor of cardiovascular disease, may also predict incident hypertension. A lot of studies have prospectively examined the relationship between plasma lipids and the future development of hypertension. Therefore I compare some studies to know the correlation between dyslipidemia and hypertension. The datas suggest that dyslipidemia may lead to the subsequent development of hypertension. Key words: obesity, dyslipidemia, hypertension, cardiovascular disease.

Introduction Obesity is one of public health problems that is important and growing rapidly nowadays around the world. In the United States, approximately one third of adults are obese and the prevalence of overweight and obesity in the pediatric population has increased substantially.1 Obesity adversely affects the major cardiovascular risk factors. The risk factors are dyslipidemia, hypertension, and type 2 diabetes mellitus. As a consequence, obese persons have an increased risk of death, especially from cardiovascular disease.2 This paper will discuss about the correlation between dyslipidemia and hypertension in obese people.

Obesity Obesity is defined as abnormal excess fat accumulation in body. The major measure for obesity is the body mass index (BMI), a Category Underweight Normal Overweight Obese Range < 18,5 18,5 24,9 25 29,9 30

persons weight (in kilograms) devided by the square of the height (in meters).3

Dyslipidemia Dyslipidemia is elevation of total cholesterol, hypertrigliceridemia, elevated lowdensity lipoprotein cholesterol (LDL-C), reduced high-density lipoprotein (HDL-C), and increased atherogenic index. The diagnosis is by measuring fasting plasma levels of total cholesterol, triglycerides, and individual lipoproteins.4 Lipoproteins Total Cholesterol Result (mg/dL) < 200 200 239 240 Meaning Desirable Borderline high High
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LDL Cholesterol

HDL Cholesterol Triglyceride

< 100 100 159 160 < 40 60 < 150 150 199 200

Optimal Borderline high High Low High Desirable Borderline high High

Hypertension Hypertension is a condition in which the blood pressure is chronically elevated. Routine measurement is needed to make the diagnosis. The JNC VII classification is used to know the grades.5 Category Normal Prehypertension Hypertension Stage 1 Stage 2 Systolic (mmHg) < 120 120 139 140 159 160 Diastolic (mmHg) < 80 80 89 90 99 100

Discussion Many articles show that obesity has an adverse effect to body. There will be blood alteration like elevation of plasma cholesterol and reduced high-density lipoprotein which is resulting dyslipidemia. This alteration makes the blood become more viscous. The viscous blood slows the blood flow. Dyslipidemia is one of the main risk factors leading to atherosclerosis and rigidity of blood vessel by endothelial damage mechanism.6 It is known that rigid blood vessel combine with the loss of psychological vasomotor activity will increase the pressure, so hypertension and dyslipidemia are closely interrelated.7 Hypertension and dyslipidemia share many characteristics. They are both risk factors for cardiovascular disease. They are generally considered to be asymptomatic conditions and
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they require lifetime therapy which may include pharmacotherapy and lifestyle changes such as dietary modification, weight loss, and exercise. For this reason, one might hypothesis that hypertension has a correlation with dyslipidemia.8 The study from Akintunde et al. revealed about half of newly diagnosed subjects with hypertension had either isolated or combined dyslipidemia associated with the hypertension and the prevalence of dyslipidemia is higher among hypertensive subjects in Nigeria.7 Other study in US was held by McDonald to establish the risk factors for cardiovascular disease in elderly also found that dyslipidemia is associated with hypertension. Data collected from participants in the National Health and Nutrition Examination Survey 1999-2004 show the prevalence of hypertension in men is 63% and the dyslipidemia is 60,3%.9 As I wrote before, hypertension and dyslipidemia is one of the risk factors for cardiovascular disease. Of the numerous factors that contribute to cardiovascular risk, hypertension and dyslipidemia have strong associations with cardiovascular, and are prevalent either alone or in combination. The interaction between cardiovascular disease risk factors is such that the probability of a cardiovascular event is frequently greater in patients with only moderate blood pressure and cholesterol abnormalities in the presence of additional risk factors than in patients with isolated marked elevations in blood pressure or cholesterol levels alone. Moreover, the prevalence of hypertension and hypercholesterolemia increases with age. This shows the relation of dyslipidemia and hypertension.10 In developed countries, dyslipidemia is more common than hypertension. A recent analysis of the National Health and Nutrition Examination Survey 1999-2000 data indicated a prevalence of dyslipidemia of 56% in men and 54% in women. A study conducted in French

adults younger than 55 years old demonstrated that more than 50% of patients with hypertension also had dyslipidemia.11 Weight gain increases the tendency for cardiovascular risk factors to cluster in persons with hypertension. It is investigated the prevalence of hypertension and dyslipidemia in relation to body mass index using data from NHANES III. In individuals under 60 years of age, the prevalence of high blood pressure increased with body mass index. Similarly, the prevalence of dyslipidemia rose with body mass index in both sexes and within all racial or ethnic groups.11 In the Physicians Health Study, total cholesterol, non-high-density lipoprotein (HDL)-cholesterol and HDL-cholesterol predicted onset of hypertension in 3110 men without self-reported hypertension. These findings agree with some of the few prospective studies on dyslipidaemia and incident hypertension. Thus, hypertension may be a consequence of dyslipidaemia or closely related metabolic abnormalities. Little is known of the association between other features of dyslipidaemia, such as apolipoprotein A, apolipoprotein B, or triglyceride content of the low-density lipoprotein (LDL) or HDL particles, and incident hypertension. Elevated triglyceride-rich lipoproteins, VLDL, small dense LDL particles and apolipoprotein B and low HDL cholesterol and apolipoprotein A are characteristic features of dyslipidaemia in the metabolic syndrome and type 2 diabetes. In addition to reverse cholesterol transport, HDL cholesterol stimulates nitric oxide (NO) production, inhibits adhesion of monocytes to endothelium, and has antithrombotic and antioxidant effects. In contrast, LDL cholesterol and triglycerides may damage the epithelium, impair NO release and cause endothelial dysfunction. Therefore, dyslipidaemia could cause hypertension by mechanisms only partly related to obesity and insulin resistance.12

Conclusion Dyslipidemia often found in obese people which shows the abnormality cholesterol level in blood. Increased of plasma cholesterol and atherogenic agents makes the blood become more viscous and forms plaque in the wall of blood vessel and caused endothelial damage. The plaque then alters the elasticity of blood vessels turns rigid. This rigidity increases the pressure in the vessel. A lot of studies have been done to prove the effect of dyslipidemia to blood vessel. There are epidemiological studies found the correlation between dyslipidemia and hypertension. From the studies above, it is believed that dyslipidemia strongly leads to hypertension.

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