July 1989

The Deadly QuartetUpper-Body Obesity, Glucose Intolerance, Hypertriglyceridemia, and Hypertension

Author Affiliations

From the Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas.

Arch Intern Med. 1989;149(7):1514-1520. doi:10.1001/archinte.1989.00390070054005

• 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.

(Arch Intern Med. 1989;149:1514-1520)