STATE-OF-THE-ART PAPER
Obesity and Cardiovascular DiseaseRisk Factor, Paradox, and Impact of Weight Loss
Carl J. Lavie, MD*,
Richard V. Milani, MD and
Hector O. Ventura, MD
Ochsner Medical Center, New Orleans, Louisiana
Manuscript received October 21, 2008;
revised manuscript received December 2, 2008,
accepted December 9, 2008.
* Reprint requests and correspondence: Dr. Carl J. Lavie, Cardiac Rehabilitation, Exercise Laboratories, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, Louisiana 70121-2483 (Email: clavie{at}ochsner.org).
Obesity has reached global epidemic proportions in both adults and children and is associated with numerous comorbidities, including hypertension (HTN), type II diabetes mellitus, dyslipidemia, obstructive sleep apnea and sleep-disordered breathing, certain cancers, and major cardiovascular (CV) diseases. Because of its maladaptive effects on various CV risk factors and its adverse effects on CV structure and function, obesity has a major impact on CV diseases, such as heart failure (HF), coronary heart disease (CHD), sudden cardiac death, and atrial fibrillation, and is associated with reduced overall survival. Despite this adverse association, numerous studies have documented an obesity paradox in which overweight and obese people with established CV disease, including HTN, HF, CHD, and peripheral arterial disease, have a better prognosis compared with nonoverweight/nonobese patients. This review summarizes the adverse effects of obesity on CV disease risk factors and its role in the pathogenesis of various CV diseases, reviews the obesity paradox and potential explanations for these puzzling data, and concludes with a discussion regarding the current state of weight reduction in the prevention and treatment of CV diseases.
Key Words: obesity • cardiovascular disease • weight loss
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | BMI = body mass index | | CHD = coronary heart disease | | CR = concentric remodeling | | CRP = C-reactive protein | | CV = cardiovascular | | DM = diabetes mellitus | | HF = heart failure | | HTN = hypertension | | LA = left atrial | | LV = left ventricular | | LVH = left ventricular hypertrophy | | MI = myocardial infarction | | OSA = obstructive sleep apnea | | PAD = peripheral arterial disease | | SCD = sudden cardiac death | | WC = waist circumference | | WHR = waist-to-hip ratio |
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