Overview of Epidemiology and Contribution of Obesity to Cardiovascular Disease
Abstract
The prevalence of obesity has increased worldwide and is a source of concern since the negative consequences of obesity start as early as in childhood. The most commonly used anthropometric tool to assess relative weight and classify obesity is the body mass index (BMI); BMI alone shows a U- or a J-shaped association with clinical outcomes and mortality. Such an inverse relationship fuels a controversy in the literature, named the 'obesity paradox', which associates better survival and fewer cardiovascular (CV) events in patients with elevated BMI afflicted with chronic diseases compared to non-obese patients. However, BMI cannot make the distinction between an elevated body weight due to high levels of lean vs. fat body mass. Generally, an excess of body fat (BF) is more frequently associated with metabolic abnormalities than a high level of lean body mass. Another explanation for the paradox is the absence of control for major individual differences in regional BF distribution. Adipose tissue is now considered as a key organ regarding the fate of excess dietary lipids, which may determine whether or not body homeostasis will be maintained (metabolically healthy obesity) or a state of inflammation/insulin resistance will be produced, with deleterious CV consequences. Obesity, particularly visceral obesity, also induces a variety of structural adaptations/alterations in CV structure/function. Adipose tissue can now be considered as an endocrine organ orchestrating crucial interactions with vital organs and tissues such as the brain, the liver, the skeletal muscle, the heart and blood vessels themselves. Thus, the evidence reviewed in this paper suggests that adipose tissue quality/function is as important, if not more so, than its amount in determining the overall health and CV risks of overweight/obesity.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Low testosterone and obesity increase the risk of major adverse cardiac events.
“Studies have shown that both low testosterone and obesity increase the risk of major adverse cardiac events (16,17).”
From Non-testosterone management of male hypogonadism: an examination of the existing literature (2020) · cites this paper as [17]
Cites
Positional cloning of the mouse obese gene and its human homologue
Zhang, Y., Proenca, R., Maffei, M., Barone, M., Leopold, L., & Friedman, J. M. (1994) · Nature · doi:10.1038/372425a0 · Cited by 13,419 · see citing works
Obesity is associated with macrophage accumulation in adipose tissue
Weisberg, S. P., McCann, D., Desai, M., Rosenbaum, M., Leibel, R. L., & Ferrante, A. W. (2003) · Journal of Clinical Investigation · doi:10.1172/jci200319246 · Cited by 10,041 · see citing works
Obesity induces a phenotypic switch in adipose tissue macrophage polarization
Lumeng, C. N., Bodzin, J. L., & Saltiel, A. R. (2007) · Journal of Clinical Investigation · doi:10.1172/jci29881 · Cited by 4,664 · see citing works
Poirier, P., Giles, T. D., Bray, G. A., Hong, Y., Stern, J. S., Pi-Sunyer, F. X., & Eckel, R. H. (2006) · Circulation · doi:10.1161/circulationaha.106.171016 · Cited by 3,165 · see citing works
Self-citationObesity and the risk of heart failure
Kenchaiah, S., Evans, J. C., Levy, D., Wilson, P. W. F., Benjamin, E. J., Larson, M. G., Kannel, W. B., & Vasan, R. S. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa020245 · Cited by 3,093 · see citing works
Overweight and obesity in the United States: prevalence and trends, 1960–1994
Flegal, K., Carroll, M., Kuczmarski, R., & Johnson, C. (1998) · International Journal of Obesity · doi:10.1038/sj.ijo.0800541 · Cited by 3,045 · see citing works
Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes
The Look AHEAD Research Group (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1212914 · Cited by 2,908 · see citing works
Mechanisms linking obesity with cardiovascular disease
Van Gaal, L. F., Mertens, I. L., & De Block, C. E. (2006) · Nature · doi:10.1038/nature05487 · Cited by 2,814 · see citing works
A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease
(2009) · New England Journal of Medicine · doi:10.1056/nejmoa0805796 · Cited by 1,939 · see citing works
Body Fat Distribution and Risk of Cardiovascular Disease: An Update
Després, J.-P. (2012) · Circulation · doi:10.1161/circulationaha.111.067264 · Cited by 1,481 · see citing works
Self-citationUnger, R. H. (2002) · Annual Review of Medicine · doi:10.1146/annurev.med.53.082901.104057 · Cited by 875 · see citing works
Reduced Adipose Tissue Oxygenation in Human Obesity
Pasarica, M., Sereda, O. R., Redman, L. M., Albarado, D. C., Hymel, D. T., Roan, L. E., Rood, J. C., Burk, D. H., & Smith, S. R. (2009) · Diabetes · doi:10.2337/db08-1098 · Cited by 786 · see citing works
Brochu, M., Tchernof, A., Dionne, I. J., Sites, C. K., Eltabbakh, G. H., Sims, E. A. H., & Poehlman, E. T. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.3.7365 · Cited by 443 · see citing works
Freedman, D. S., Dietz, W. H., Tang, R., Mensah, G. A., Bond, M. G., Urbina, E. M., Srinivasan, S., & Berenson, G. S. (2004) · International Journal of Obesity · doi:10.1038/sj.ijo.0802515 · Cited by 244 · see citing works
Frystyk, J., Berne, C., Berglund, L., Jensevik, K., Flyvbjerg, A., & Zethelius, B. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-1067 · Cited by 201 · see citing works
Visceral fat and coronary pathology in male adolescents
Kortelainen, M.-L., & Särkioja, T. (2001) · International Journal of Obesity · doi:10.1038/sj.ijo.0801466 · Cited by 46 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Neeland, I. J., Poirier, P., & Després, J.-P. (2018) · Circulation · doi:10.1161/circulationaha.117.029617 · Cited by 881 · see citing works
Self-citationWewege, M., van den Berg, R., Ward, R. E., & Keech, A. (2017) · Obesity Reviews · doi:10.1111/obr.12532 · Cited by 661 · see citing works
Piché, M.-E., Poirier, P., Lemieux, I., & Després, J.-P. (2018) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2018.06.004 · Cited by 558 · see citing works
Self-citationAssociation between psychosocial stress and hypertension: A systematic review and meta-analysis
Liu, M.-Y., Li, N., Li, W. A., & Khan, H. (2017) · Neurological Research · doi:10.1080/01616412.2017.1317904 · Cited by 546 · see citing works
Meta-analysis on shift work and risks of specific obesity types
Sun, M., Feng, W., Wang, F., Li, P., Li, Z., Li, M., Tse, G., Vlaanderen, J., Vermeulen, R., & Tse, L. A. (2018) · Obesity Reviews · doi:10.1111/obr.12621 · Cited by 391 · see citing works
Targeting autophagy in obesity: from pathophysiology to management
Zhang, Y., Sowers, J. R., & Ren, J. (2018) · Nature Reviews Endocrinology · doi:10.1038/s41574-018-0009-1 · Cited by 338 · see citing works
Healthy obese versus unhealthy lean: the obesity paradox
Lavie, C. J., De Schutter, A., & Milani, R. V. (2015) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2014.165 · Cited by 266 · see citing works
Management of cardiovascular diseases in patients with obesity
Lavie, C. J., Arena, R., Alpert, M. A., Milani, R. V., & Ventura, H. O. (2018) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2017.108 · Cited by 218 · see citing works
Scheepers, L. E. J. M., Penders, J., Mbakwa, C. A., Thijs, C., Mommers, M., & Arts, I. C. W. (2015) · International Journal of Obesity · doi:10.1038/ijo.2014.178 · Cited by 162 · see citing works
Ko, C.-H., Lin, H.-C., Lin, P.-C., & Yen, J.-Y. (2020) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867419881499 · Cited by 136 · see citing works
Bell, C. N., Kerr, J., & Young, J. L. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16050861 · Cited by 115 · see citing works
In Kim, H., Kim, J.-K., Kim, J.-Y., Jang, S.-E., Han, M. J., & Kim, D.-H. (2019) · Nutrition Research · doi:10.1016/j.nutres.2019.03.008 · Cited by 82 · see citing works
Obesity associated disease risk: the role of inherent differences and location of adipose depots
Hill, J. H., Solt, C., & Foster, M. T. (2018) · Hormone Molecular Biology and Clinical Investigation · doi:10.1515/hmbci-2018-0012 · Cited by 79 · see citing works
Simões, D., Araújo, F. A., Severo, M., Monjardino, T., Cruz, I., Carmona, L., & Lucas, R. (2017) · Arthritis Care & Research · doi:10.1002/acr.22996 · Cited by 62 · see citing works
Changing the Endpoints for Determining Effective Obesity Management
Ross, R., Blair, S., de Lannoy, L., Després, J.-P., & Lavie, C. J. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2014.10.002 · Cited by 55 · see citing works
Self-citationValencia, W. M., Stoutenberg, M., & Florez, H. (2014) · Current Diabetes Reports · doi:10.1007/s11892-014-0539-4 · Cited by 37 · see citing works
Non-testosterone management of male hypogonadism: an examination of the existing literature
Krzastek, S. C., & Smith, R. P. (2020) · Translational Andrology and Urology · doi:10.21037/tau.2019.11.16 · Cited by 34 · see citing works
“Studies have shown that both low testosterone and obesity increase the risk of major adverse cardiac events (16,17).”
BackgroundPharmacological Treatment of Obesity in Older Adults
Žižka, O., Haluzík, M., & Jude, E. B. (2024) · Drugs & Aging · doi:10.1007/s40266-024-01150-9 · Cited by 23 · see citing works
Camhi, S. M., Debordes-Jackson, G., Andrews, J., Wright, J., Lindsay, A. C., Troped, P. J., & Hayman, L. L. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168726 · Cited by 12 · see citing works
- Authors
- Bastien, M., Poirier, P., Lemieux, I., & Després, J.-P.
- Affiliations
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- Corresponding author
- Poirier, Paul
- Venue
- Progress in Cardiovascular Diseases
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 56
- Issue
- 4
- Pages
- 369-381
- ISSN
- 0033-0620 (ISSN-L)
- OpenAlex
- W2057830475
- Cited by
- 1,125
- References
- 16
- Citations by year
- 2026: 30 · 2025: 56 · 2024: 74 · 2023: 74 · 2022: 78 · 2021: 93 · 2020: 116 · 2019: 104 · 2018: 130 · 2017: 112 · 2016: 105 · 2015: 106 · 2014: 45 · 2012: 1
- FWCI
- 13.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Progress in Cardiovascular Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- obesity, cardiovascular disease, obesity paradox, body mass index, body fat distribution, visceral obesity, metabolically healthy obesity, adipose tissue endocrine function, insulin resistance, inflammation, cardiovascular risk, lean body mass, childhood obesity
- MeSH terms
- Adolescent, Adult, Aged, Cardiovascular Diseases, Child, Female, Humans, Male, Middle Aged, Obesity, Obesity, Morbid, Prognosis, Global Health, Comorbidity, Body Mass Index, Prevalence, Age Distribution, Sex Distribution, Risk Assessment, Abdominal Fat, Body Fat Distribution, Pediatric Obesity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
