Obesity and cardiovascular risk in down syndrome: Challenges and updated management

Down syndrome (DS) or trisomy 21 is a genetic condition presenting with intellectual disabilities, distinctive phenotypic features, and multisystem involvement. As life expectancy in individuals with DS increases, obesity has emerged as a significant and growing clinical concern. Although obesity is highly prevalent among DS patients, its contribution in shaping cardiovascular risk has not been comprehensively synthesized in the existing literature. Studies published between January 2000 and March 2026 were identified through searches of PubMed and ScienceDirect, supplemented by manual screening of reference lists. In total, 65 studies met the inclusion criteria. Evidence indicates that individuals with DS commonly exhibit increased central adiposity, altered metabolic and adipokine profiles, adverse lipid abnormalities, sedentary behavior, and a higher prevalence of sleep apnea, all of which may contribute to downstream cardiometabolic and cardiovascular strain. However, findings on insulin resistance remain varied, and much of the available evidence is cross-sectional and based on intermediate risk markers rather than on longitudinal cardiovascular outcomes. Overall, the current literature supports obesity in DS as a clinically relevant and probable amplifier of cardiovascular risk. Early, targeted strategies centred on nutrition, physical activity, and caregiver-supported interventions may help mitigate long-term burden. Although DS-specific longitudinal and interventional studies remain needed.