Obesity and Cardiovascular Diseases

Abstract

Obesity has been increasing in epidemic proportions, with a disproportionately higher increase in morbid or class III obesity, and obesity adversely affects cardiovascular (CV) hemodynamics, structure, and function, as well as increases the prevalence of most CV diseases. Progressive declines in physical activity over 5 decades have occurred and have primarily caused the obesity epidemic. Despite the potential adverse impact of overweight and obesity, recent epidemiological data have demonstrated an association of mild obesity and, particularly, overweight on improved survival. We review in detail the obesity paradox in CV diseases where overweight and at least mildly obese patients with most CV diseases seem to have a better prognosis than do their leaner counterparts. The implications of cardiorespiratory fitness with prognosis are discussed, along with the joint impact of fitness and adiposity on the obesity paradox. Finally, in light of the obesity paradox, the potential value of purposeful weight loss and increased physical activity to affect levels of fitness is reviewed.

Obesity and Cardiovascular Disease

“…More detailed information the pathophysiology and hemodynamics of CVD is provided elsewhere. [9][10][11] This notion is supported by recent studies that have observed a positive association between FFM/lean mass and CVD risk factors in young people. [12][13][14][15] Bigaard et al 16 observed a reversed J-shape association between FFM index (FFM in kg divided by squared height [m]) and all-cause mortality, using bioelectrical impedance to assess body composition and additionally adjusting by FM index (FM in kg divided by squared height [m]) what could have attenuated the association because it is known that obese people have both high FM and high FFM.…”

“…9,10,120,121 In addition, obesity adversely affects CV structure and function, including increasing the prevalence of LV structural abnormalities, including causing concentric remodeling and LV hypertrophy, increasing left atrial enlargement, and leading to abnormalities in both systolic and, especially, LV diastolic function ( Figure 6). 10 Therefore, it is not surprising that almost all CVD is increased in a setting of obesity, including CHD, HF, hypertension, and atrial fibrillation.…”

“…10 Therefore, it is not surprising that almost all CVD is increased in a setting of obesity, including CHD, HF, hypertension, and atrial fibrillation. 9,10,120 However, despite these adverse effects on CVD risk factors and increasing the prevalence of CVD, now numerous studies and meta-analyses have demonstrated a strong obesity paradox, where CVD patients with overweight and obesity (at least mild obesity) seem to have a better prognosis than do their leaner counterparts with the same CVD. 9,10,120,121 The obesity paradox was first shown in patients with endstage renal failure, in whom obesity was shown to be related to a more favorable prognosis.…”

Is There an Obesity Paradox for Outcomes in Atrial Fibrillation?

“…4 A better prognosis, both in terms of all-cause and cardiovascular death, for overweight and obese patients has been reported for patients diagnosed with hypertension, coronary artery disease, congestive heart failure, and peripheral arterial disease. 6 Indeed, our systematic review shows several studies in AF patients in which an obesity paradox was evident. This phenomenon was most evident in RCT-derived cohorts, whereas in observational studies, the differences in adverse outcomes were no longer apparent after statistical adjustments for associated comorbidities in obese patients, leading to more intense risk factor management and hence improved outcomes.…”

“…4,5 Several studies have found an obesity paradox is evident in patients with established cardiovascular disease, including hypertension, coronary heart disease, and chronic heart failure. 6 An obesity paradox may also be evident in primary prevention patients. 7 Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia, and the relationship between obesity and AF is well established.…”