Invited Commentary

Commentary on "Association of Body Mass Index and Waist Circumference with Subclinical Atherosclerosis in Retired NFL Players"

Authors: Raul D. Santos, MD, PhD


Exercise is pivotal for the prevention of cardiovascular disease (CVD). Unfortunately, there is no legacy effect; one can exercise frequently when young and because of the usual circumstances of modern life, become sedentary in adulthood. When one stops exercising, over time the benefits to cardiovascular fitness, blood pressure, lipids, insulin sensitivity, coagulation, and inflammation tend to vanish. As such, people should attempt to remain active for the rest of their lives so that they may ‘‘live long and prosper.’’ Indeed, lack of exercise has been associated with many diseases that can predispose people to CVD such as obesity, atherogenic dyslipidemia, hypertension, insulin resistance, and type 2 diabetes mellitus. The concept of the metabolic syndrome was created as a clinical entity signalling an elevated risk of type 2 diabetes mellitus and CVD that is associated with, and almost certainly caused by, increased body adiposity.1 One of the pivotal components of metabolic syndrome is an elevated waist circumference (WC), a marker of increased abdominal adiposity. Abdominal or visceral adipocytes are endocrine cells that secrete adipocytokines predisposing to insulin resistance, dyslipidemia, and inflammation differently from peripheral adipocytes that are more like a fat depot.

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1. Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol 2008;28:629-636.
2. Carmienke S, Freitag MH, Pischon T, et al. General and abdominal obesity parameters and their combination in relation to mortality: a systematic review and meta-regression analysis. Eur J Clin Nutr 2013;67:573-585.
3. Selden MA, Helzberg JH, Waeckerle JF. Early cardiovascular mortality in professional football players: fact or fiction? Am J Med 2009;122:811-814.
4. Pokharel Y, Basra S, Lincoln AE, et al. Association of body mass index and waist circumference with subclinical atherosclerosis in retired NFL players. South Med J 2014;107:633-639.
5. Santos RD, Nasir K. Insights into atherosclerosis from invasive and non-invasive imaging studies: should we treat subclinical atherosclerosis? Atherosclerosis 2009;205:349-356.
6. Pandey AK, Pandey S, Blaha MJ, et al. Family history of coronary heart disease and markers of subclinical cardiovascular disease: where do we stand? Atherosclerosis 2013;228:285-294.
7. Lee CD, Jacobs DR Jr, Hankinson A, et al. Cardiorespiratory fitness and coronary artery calcification in young adults: the CARDIA Study. Atherosclerosis 2009;203:263-268.