Update: systemic diseases and the cardiovascular system (i): obesity and the heart

Area of Science:

• Cardiology
• Metabolic Diseases
• Public Health

Background:

• Excess weight is the leading cardiovascular risk factor, particularly in patients with existing cardiovascular disease.
• Obesity's link to cardiovascular disease (CVD) involves complex mechanisms beyond traditional risk factors, including inflammation, endothelial dysfunction, and obstructive sleep apnea.
• Paradoxical findings exist regarding obesity and prognosis in coronary heart disease and heart failure, suggesting current obesity definitions may be insufficient.

Purpose of the Study:

• To explore the multifaceted relationship between obesity and cardiovascular disease.
• To examine the mechanisms through which obesity contributes to CVD.
• To discuss the limitations of current obesity metrics and management strategies.

Main Methods:

• Review of existing literature on obesity and cardiovascular disease.
• Analysis of studies investigating obesity-related pathophysiological mechanisms.
• Evaluation of evidence on obesity measurement and management.

Main Results:

• Obesity contributes to CVD through inflammation, endothelial dysfunction, sympathetic overactivity, dyslipidemia, hypercoagulability, and obstructive sleep apnea.
• Body mass index (BMI) may not accurately reflect obesity-related cardiovascular risk; central obesity and total body fat are potentially better indicators.
• Lifestyle modifications and pharmacotherapy show limited long-term success in weight management, with high regain rates.

Conclusions:

• Obesity is a critical and persistent cardiovascular risk factor.
• More accurate measures of obesity, such as central adiposity, are needed for better risk assessment.
• Bariatric surgery offers effective long-term weight loss for severe and complicated obesity but has limited accessibility.