The Deadly Quartet

TLDR

Upper‑body obesity, often overlooked, contributes to cardiovascular risk by linking to hypertension, diabetes, and hypertriglyceridemia even when overall obesity is mild. The article investigates whether upper‑body obesity driven by caloric excess and androgens causes these metabolic disorders via hyperinsulinemia, and calls for prevention or therapies that avoid worsening hyperinsulinemia. Arch Intern Med 1989;149:1514‑1520.

Abstract

• The contribution of obesity to cardiovascular risk has not been adequately appreciated because of a failure to recognize the involvement of upper-body predominance of body weight with hypertension, diabetes, and hypertriglyceridemia even in the absence of significant overall obesity. This article examines the evidence that upper-body obesity, as usually induced by caloric excess in the presence of androgens, mediates these problems by way of hyperinsulinemia. Because of these interrelationships, there is a need to identify and prevent upper-body obesity or, failing that, to provide therapies that will control the associated problems without aggravating hyperinsulinemia. (<i>Arch Intern Med</i>. 1989;149:1514-1520)