Management of cardiovascular diseases in patients with obesity
Abstract
The management of cardiovascular diseases (CVD) in patients with obesity presents numerous challenges. Obesity has a negative effect on almost all of the major CVD risk factors, and adversely influences cardiovascular structure and function. Patients who are overweight or obese have a higher incidence of almost all CVDs compared with patients who are of normal weight. However, those who are overweight or obese seem to have a better short-term and medium-term prognosis after major CVD events and interventional procedures or cardiac surgeries than leaner patients, a phenomenon termed the 'obesity paradox'. In considering the mechanisms underlying this paradox, we review evidence of the deleterious consequences of obesity in patients with coronary heart disease, and the limited data on the benefits of weight loss in patients with CVD. Additional studies are needed on the efficacy of purposeful weight loss on cardiovascular outcomes to determine the ideal body composition for patients with CVD.
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Obesity is associated with eccentric and concentric left ventricular hypertrophy.
“Thus, obesity is associated with eccentric and concentric LVH36,41.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [41]
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Effects of obesity on lower extremity muscle function during walking at two speeds
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Self-citationStrain Imaging in Morbid Obesity: Insights Into Subclinical Ventricular Dysfunction
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Surgical Management of Obesity and the Relationship to Cardiovascular Disease
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Self-citationCurrent Perspectives on Left Ventricular Geometry in Systemic Hypertension
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Self-citationThe alterations in left ventricular structure and function in young healthy obese women
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Self-citationImpact of Obesity on the Pathogenesis and Prognosis of Coronary Heart Disease
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Self-citationRelation of Epicardial Fat Thickness to Right Ventricular Cavity Size in Obese Subjects
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Self-citationDifferential Changes in Exercise Performance After Massive Weight Loss Induced by Bariatric Surgery
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Self-citationRelative fat-free mass deficiency and left ventricular adaptation to obesity: The Strong Heart Study
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The Impact of Isolated Obesity on Right Ventricular Function in Young Adults
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Self-citationChronic Coronary Artery Disease: A Companion to Braunwald's Heart Disease
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Overweight and Obesity as Determinants of Cardiovascular Risk: The Framingham Experience
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Effects of Left Ventricular Geometry and Obesity on Mortality in Women With Normal Ejection Fraction
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Self-citationThe six-minute step test as a predictor of cardiorespiratory fitness in obese women.
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Self-citationAdvances in the Prevention and Treatment of Atrial Fibrillation
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Self-citationLeft Ventricular Geometric Patterns In Obese Nigerian Adults: An Echocardiographic Study.
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Self-citationThe combination of obesity and hypertension
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Obesity Phenotypes, Diabetes, and Cardiovascular Diseases
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“27,28 The most commonly reported arrhythmias are atrial fibrillation and ventricular tachycardia.”
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The science of obesity management: an endocrine society scientific statement
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An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases
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Self-citationObesity, kidney dysfunction and hypertension: mechanistic links
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“Consequently, almost all CVD is increased in obesity, especially heart failure (HF) (7), but also HTN, coronary heart disease (CHD), atrial fibrillation (AF), as well as most other CVD (1,2,7,8).”
BackgroundSelf-citationST-segment elevation myocardial infarction
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Obesity paradox in cardiovascular disease: where do we stand?
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“29 In animal models, these cytokines induce a reversible cardiac dysfunction when administered to healthy mice, 44 – 46 which have prompted investigation of therapeutics targeting these cytokines in clinical trials in patients with HF. 47,48 Furthermore, obesity is typically associated with a Westernized diet rich in…”
InfluentialSelf-citationA Review of Obesity, Physical Activity, and Cardiovascular Disease
Elagizi, A., Kachur, S. M., Carbone, S., Lavie, C. J., & Blair, S. N. (2020) · Current Obesity Reports · doi:10.1007/s13679-020-00403-z · Cited by 329 · see citing works
Self-citationUpdates on obesity and the obesity paradox in cardiovascular diseases
Tutor, A. W., Lavie, C. J., Kachur, S. M., Milani, R. V., & Ventura, H. O. (2022) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2022.11.013 · Cited by 301 · see citing works
Self-citationSharifi‐Rad, J., Rodrigues, C. F., Sharopov, F. S., Docea, A. O., Karaça, A. C., Sharifi‐Rad, M., Kahveci, D., Gülseren, G., Şenol, E., Demircan, E., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17072326 · Cited by 295 · see citing works
“Several chronic diseases linked to obesity, including CVDs [33,67] type II diabetes [68], hypertension [69], musculoskeletal disorders [70], and certain types of cancer [71].”
BackgroundAssociation Between Obesity and Cardiovascular Outcomes: Updated Evidence from Meta-analysis Studies
Dwivedi, A. K., Dubey, P., Cistola, D. P., & Reddy, S. (2020) · Current Cardiology Reports · doi:10.1007/s11886-020-1273-y · Cited by 281 · see citing works
Moholdt, T. T., Lavie, C. J., & Nauman, J. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.01.011 · Cited by 173 · see citing works
Self-citationThe gut microbiome and elevated cardiovascular risk in obesity and autoimmunity
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Association of metabolic syndrome and chronic kidney disease
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Activating transcription factor 3 in cardiovascular diseases: a potential therapeutic target
Zhou, H., Li, N., Yuan, Y., Jin, Y., Guo, H., Deng, W., & Tang, Q. (2018) · Basic Research in Cardiology · doi:10.1007/s00395-018-0698-6 · Cited by 122 · see citing works
Interventions to promote cardiometabolic health and slow cardiovascular ageing
Fontana, L. (2018) · Nature Reviews Cardiology · doi:10.1038/s41569-018-0026-8 · Cited by 94 · see citing works
Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test
Yanagawa, B., Graham, M. M., Afilalo, J., Hassan, A., & Arora, R. C. (2018) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2018.01.103 · Cited by 93 · see citing works
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Obesity, Cardiorespiratory Fitness, and Cardiovascular Disease
Haidar, A., & Horwich, T. B. (2023) · Current Cardiology Reports · doi:10.1007/s11886-023-01975-7 · Cited by 80 · see citing works
“Overall, despite numerous studies and analyses that have demonstrated an obesity paradox in patients with CVD, an improved prognosis has been consistently seen in association with increased physical activity, exercise training, and higher levels of cardiorespiratory fitness [24, 27, 38, 49].”
BackgroundInfluentialUltra-Processed Food Intake and Increased Risk of Obesity: A Narrative Review
Monda, A., de Stefano, M. I., Villano, I., Allocca, S., Casillo, M., Messina, A., Monda, V., Moscatelli, F., Dipace, A., Limone, P., et al. (2024) · Foods · doi:10.3390/foods13162627 · Cited by 97 · see citing works
“Obesity leads to the onset of metabolic syndrome [24], defined by the National Institutes of Health as a procession of closely related metabolic dysfunctions, including abdominal adiposity, hy-Foods percholesterolemia, hypertension, and impaired fasting glycemia [24].”
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Obesity and Stroke: Does the Paradox Apply for Stroke?
Quiñones-Ossa, G. A., Lobo, C., García-Ballestas, E., Florez-Perdomo, W. A., Moscote‐Salazar, L. R., & Agrawal, A. (2021) · Neurointervention · doi:10.5469/neuroint.2020.00108 · Cited by 67 · see citing works
“BMI has been criticized because it does not differentiate fatness, obesity, and adiposity measurement.(11,29,32,39,40) Other methods, including waist circumference and central and peripheral fat mass, have also been proposed for the diagnosis; still, BMI continues to be used for the classification of obesity.”
BackgroundWen, J.-J., Li, M., Gao, H., Hu, J., Nie, Q., Chen, H., Zhang, Y.-L., Xie, M., & Nie, S. (2021) · Food & Function · doi:10.1039/d0fo02600j · Cited by 68 · see citing works
Challenges in Cardiovascular Evaluation and Management of Obese Patients
Bianchettin, R. G., Lavie, C. J., & López-Jiménez, F. A. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.11.031 · Cited by 71 · see citing works
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Obesity and Peripheral Artery Disease: Current Evidence and Controversies
Lempesis, I. G., Varrias, D., Sagris, Μ., Attaran, R., Altin, E. S., Bakoyiannis, C., Palaiodimos, L., Dalamaga, Μ., & Kokkinidis, D. G. (2023) · Current Obesity Reports · doi:10.1007/s13679-023-00510-7 · Cited by 60 · see citing works
Reprint of: Healthy Weight and Obesity Prevention
Lavie, C. J., Laddu, D., Arena, R. A., Ortega, F. B., Alpert, M., & Kushner, R. F. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.024 · Cited by 58 · see citing works
Self-citationImplications of obesity across the heart failure continuum
Elagizi, A., Carbone, S., Lavie, C. J., Mehra, M. R., & Ventura, H. O. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.09.005 · Cited by 58 · see citing works
“The obesity paradox is typically seen in mild obesity, and far less in severely obese subjects, who seem to lose any potential survival advantage associated with obesity.(8,9,22,23) Recently, however, even those with severe obesity have shown to present favorable outcomes compared to leaner patients.”
Self-citationThe Potency of Moringa oleifera Lam. as Protective Agent in Cardiac Damage and Vascular Dysfunction
Alia, F., Putri, M., Anggraeni, N., & Syamsunarno, M. R. A. A. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.724439 · Cited by 64 · see citing works
“Therefore, pharmacological treatments have been established (Mayr and Jilma, 2006; Lavie et al., 2018), as well as the study of natural products that contain various phytochemical compounds prospected to protect the heart and blood vessels from further damage (Shaito et al.”
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“Among young adults, an increase in muscle mass, represented as predicted LBMI and ASMI, or a decrease in fat mass, represented as predicted BFMI, was associated with a reduction in the risk of developing CVD. Conversely, a decrease in muscle mass or an increase in fat mass was associated with a significant elevation i…”
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“Most studies have shown that purposeful weight loss can reverse many changes in cardiac performance and morphology associated with obesity.(7) For example, purposeful weight loss reduces the total and central blood volume, myocardial oxygen consumption, and cardiac output in patients with obesity.”
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“second leading cause of preventable death in high-income countries, behind cigarette smoking.(21) 22 The prevalence of overweight and obesity continues to increase around the world, as have associated comorbidities and healthcare costs.”
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“79 Also, the relationship between higher BMI and clinical outcomes is not linear after the onset of CVD. 84,85 VAT is drained by the portal circulation with potential increased FFA delivery to the liver that has been linked to the development of fatty liver and insulin resistance.”
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“People who are obese are at an increased risk for cardiovascular diseases (Lavie et al., 2018).”
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“tive roles in an established CVD (Figure 2).(122,123)”
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“9%) [7], or with unverifiable values for weight, height, or waist circumference (n= 31; 0.”
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“32,33 Diabetes, hypertension and obesity are associated with impaired myocardial energy consumption, cardiac hypertrophy and oxidative damage.”
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- Authors
- Lavie, C. J., Arena, R., Alpert, M. A., Milani, R. V., & Ventura, H. O.
- Affiliations
- Ochsner Health System (US)
- University of Illinois Chicago (US)
- University of Missouri (US)
- Corresponding author
- Lavie, Carl J.
- Venue
- Nature Reviews Cardiology
- Published
- 2017-07-27
- Volume
- 15
- Issue
- 1
- Pages
- 45-56
- ISSN
- 1759-5002 (ISSN-L)
- 1759-5010
- OpenAlex
- W2741252257
- Cited by
- 218
- References
- 135
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 23 · 2023: 34 · 2022: 34 · 2021: 27 · 2020: 26 · 2019: 16 · 2018: 30 · 2017: 1
- FWCI
- 2.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- obesity, cardiovascular disease, obesity paradox, weight loss, coronary artery disease, cardiovascular risk factors, body composition, cardiovascular outcomes
- MeSH terms
- Cardiovascular Diseases, Humans, Obesity, Morbid, Weight Loss
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