State-of-the-Art Paper
Obesity and Cardiovascular Disease: Risk Factor, Paradox, and Impact of Weight Loss

https://doi.org/10.1016/j.jacc.2008.12.068Get rights and content
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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.

Key Words

obesity
cardiovascular disease
weight loss

Abbreviations and Acronyms

AF
atrial fibrillation
BMI
body mass index
CHD
coronary heart disease
CR
concentric remodeling
CRP
C-reactive protein
CV
cardiovascular
DM
diabetes mellitus
HF
heart failure
HTN
hypertension
LA
left atrial
LV
left ventricular
LVH
left ventricular hypertrophy
MI
myocardial infarction
OSA
obstructive sleep apnea
PAD
peripheral arterial disease
SCD
sudden cardiac death
WC
waist circumference
WHR
waist-to-hip ratio

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