Obesity and Cardiovascular Disease

Abstract

Obesity has reached global epidemic proportions in both adults and children and is associated with numerous comorbidities, including hypertension (HTN), type II diabetes mellitus, dyslipidemia, obstructive sleep apnea and sleep-disordered breathing, certain cancers, and major cardiovascular (CV) diseases. Because of its maladaptive effects on various CV risk factors and its adverse effects on CV structure and function, obesity has a major impact on CV diseases, such as heart failure (HF), coronary heart disease (CHD), sudden cardiac death, and atrial fibrillation, and is associated with reduced overall survival. Despite this adverse association, numerous studies have documented an obesity paradox in which overweight and obese people with established CV disease, including HTN, HF, CHD, and peripheral arterial disease, have a better prognosis compared with nonoverweight/nonobese patients. This review summarizes the adverse effects of obesity on CV disease risk factors and its role in the pathogenesis of various CV diseases, reviews the obesity paradox and potential explanations for these puzzling data, and concludes with a discussion regarding the current state of weight reduction in the prevention and treatment of CV diseases.

Dynamic Relation of Changes in Weight and Indices of Fat Distribution With Cardiac Structure and Function: The Dallas Heart Study

“…These mechanisms lead to pathologic LV remodeling,4, 11 and eventually heart failure 2. Variation in body fat distribution may be an important determinant of cardiac remodeling,41 and excess fat storage in the visceral depot may expose the heart to a different inflammatory and metabolic milieu than fat stored in the subcutaneous depot 42.…”

“…However, there are several limitations of BMI that have been recently described 9. Although higher BMI clearly identifies individuals at increased risk of mortality, those who are only mildly obese may have lower or similar mortality compared with normal‐weight individuals 10, 11. Additionally, BMI has never been incorporated into traditional CVD risk scores including Framingham12 or the Pooled Cohort Equation because it has not been shown to identify increased risk over traditional risk factors 13.…”

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

“…The detrimental effects of obesity on general and cardiovascular health are well recognized 1. Obesity is associated with an increased risk of coronary artery disease (CAD), heart failure, hypertension, atrial fibrillation, and many other cardiovascular conditions 1.…”

“…Obesity is associated with an increased risk of coronary artery disease (CAD), heart failure, hypertension, atrial fibrillation, and many other cardiovascular conditions 1. Adipose tissue is not a simple storehouse for fat, but rather an endocrine organ that is capable of synthesizing and releasing a variety of molecules, such as leptin, adiponectin, tumor necrosis factor‐α, interleukin‐6, and many others, that play a central role in the pathophysiological features of inflammation and CAD 2.…”

Peri-operative management of the obese surgical patient 2015

“…This results in a relative risk of 1.5 for atrial fibrillation 22, and a markedly increased risk of sudden cardiac death 23. There is an increased incidence of prolonged QT interval with increasing BMI 24, and therefore a potential increased risk with drugs such as ondansetron 25.…”