Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism
Abstract
Obesity is becoming a global epidemic in both children and adults. It is associated with numerous comorbidities such as cardiovascular diseases (CVD), type 2 diabetes, hypertension, certain cancers, and sleep apnea/sleep-disordered breathing. In fact, obesity is an independent risk factor for CVD, and CVD risks have also been documented in obese children. Obesity is associated with an increased risk of morbidity and mortality as well as reduced life expectancy. Health service use and medical costs associated with obesity and related diseases have risen dramatically and are expected to continue to rise. Besides an altered metabolic profile, a variety of adaptations/alterations in cardiac structure and function occur in the individual as adipose tissue accumulates in excess amounts, even in the absence of comorbidities. Hence, obesity may affect the heart through its influence on known risk factors such as dyslipidemia, hypertension, glucose intolerance, inflammatory markers, obstructive sleep apnea/hypoventilation, and the prothrombotic state, in addition to as-yet-unrecognized mechanisms. On the whole, overweight and obesity predispose to or are associated with numerous cardiac complications such as coronary heart disease, heart failure, and sudden death because of their impact on the cardiovascular system. The pathophysiology of these entities that are linked to obesity will be discussed. However, the cardiovascular clinical evaluation of obese patients may be limited because of the morphology of the individual. In this statement, we review the available evidence of the impact of obesity on CVD with emphasis on the evaluation of cardiac structure and function in obese patients and the effect of weight loss on the cardiovascular system.
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Better weight-loss treatment and maintenance can improve several obesity-related CHD risk factors and help lower the prevalence of the second most preventable cause of death.
“Improving weight loss treatment and maintenance can improve several of the obesity-related risk factors for CHD (e.g., insulin resistance, type 2 diabetes) and help reduce the prevalence of the second most preventable cause of death today [5–7].”
From SMART trial: A randomized clinical trial of self-monitoring in behavioral weight management-design and baseline findings (2009) · cites this paper as [6]
Obesity is becoming a worldwide epidemic in both children and adults.
“Obesity is becoming a worldwide epidemic in both children and adults.370”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [370]
Starvation, very-low-calorie diets, liquid protein diets, and obesity surgeries are associated with QTc prolongation and increased risk of malignant dysrhythmias, and various pharmacologic agents have limited efficacy or considerable toxicity.
“Certainly, starvation, very-low-calorie diets, liquid protein diets, and obesity surgeries have been associated with prolongation of the QTc interval and increased risk of malignant dysrhythmias (1), and various pharmacologic agents have either limited efficacy or considerable toxicity (70 -72).”
From Obesity and Cardiovascular Disease (2009) · cites this paper as [1]
For each 1-unit increase in BMI, the risk of ischemic stroke increases by 4% and the risk of hemorrhagic stroke increases by 6%.
“In fact, for each 1-U increase in BMI, there was an increase of 4% in the risk of ischemic stroke and 6% for hemorrhagic stroke (1,53).”
From Obesity and Cardiovascular Disease (2009) · cites this paper as [1]
The adipocyte acts as an endocrine organ and plays a substantial role in the pathogenesis and complications of obesity.
“The adipocyte acts as an endocrine organ, and plays a substantial role in the pathogenesis and complications of obesity (1,10).”
From Obesity and Cardiovascular Disease (2009) · cites this paper as [1]
A 3.0 mmHg higher systolic and 2.3 mmHg higher diastolic blood pressure translates into an estimated 12% increased risk for coronary heart disease and 24% increased risk for stroke.
“A 3.0 mmHg higher systolic and a 2.3 mmHg higher DBP translates into an estimated 12% increased risk for CHD and 24% increased risk for stroke (416).”
From Lack of Exercise Is a Major Cause of Chronic Diseases (2012) · cites this paper as [416]
Obesity, determined by having a body mass index greater than 30, affects 40% of the United States and leads to cardiovascular disease, hypertension, and type 2 diabetes.
“Obesity, determined by having a body mass index greater than 30, affects 40% of the United States and leads to cardiovascular disease, hypertension, and type 2 diabetes [57].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [57]
Many published studies have concluded that obesity is independently associated with LV hypertrophy.
“Many published studies have concluded that obesity is independently associated with LV hypertrophy (22, 28, 63, 72, 116, 235, 242, 266, 279, 284, 377).”
From Cardiac remodeling in obesity (2008) · cites this paper as [284]
Although some studies have failed to show a relationship between sleep apnea and LV hypertrophy, the majority do support such an association.
“Although some studies have failed to show a relationship between sleep apnea and LV hypertrophy, the majority do support such an association (18, 22, 69, 250, 256–258, 284, 287, 331, 373).”
From Cardiac remodeling in obesity (2008) · cites this paper as [284]
Stroke volume and cardiac output are both increased in obese individuals.
“In addition, stroke volume and cardiac output are both increased (13, 49, 165, 170, 284).”
From Cardiac remodeling in obesity (2008) · cites this paper as [284]
If maintained, these improvements are expected to translate into benefits for cardiac structure and function.
“If they are maintained, these improvements are expected to translate into benefits for cardiac structure and function (181, 284).”
From Cardiac remodeling in obesity (2008) · cites this paper as [284]
Many studies have shown that weight loss improves blood pressure, diabetes, sleep apnea, hyperlipidemia, and sympathetic/parasympathetic tone.
“Many studies have shown that weight loss improves blood pressure, diabetes, sleep apnea, hyperlipidemia, and sympathetic/parasympathetic tone (196, 284, 324, 365).”
From Cardiac remodeling in obesity (2008) · cites this paper as [284]
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- Authors
- Poirier, P., Giles, T. D., Bray, G. A., Hong, Y., Stern, J. S., Pi-Sunyer, F. X., & Eckel, R. H.
- Affiliations
- American Heart Association (US)
- Venue
- Circulation
- Published
- 2006-02-14
- Volume
- 113
- Issue
- 6
- Pages
- 898-918
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2101701509
- Cited by
- 3,165
- References
- 353
- Citations by year
- 2026: 57 · 2025: 87 · 2024: 96 · 2023: 119 · 2022: 179 · 2021: 211 · 2020: 211 · 2019: 171 · 2018: 137 · 2017: 172 · 2016: 171 · 2015: 168 · 2014: 208 · 2013: 203 · 2012: 197
- FWCI
- 71.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- 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 pathophysiology, weight loss, cardiac structure and function, coronary artery disease, heart failure, sudden cardiac death, dyslipidemia, hypertension, type 2 diabetes, obstructive sleep apnea, hypercoagulability, childhood obesity, cardiovascular risk factors
- MeSH terms
- American Heart Association, Cardiovascular Diseases, Humans, Obesity, Weight Loss
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.
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