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Clinical Research

Is hyperdynamic circulation a hallmark of obesity?

International Journal of Obesity volume 50, pages 618–625 (2026)Cite this article

Subjects

Abstract

Background

Obesity is a major contributor to cardiovascular disease. Although altered central hemodynamics have been reported in obesity, studies are few, small, and limited to specific populations, leaving these changes underrecognized. This study investigates the association between body mass index (BMI) and central hemodynamics in a large cohort of adult patients admitted for medical reasons. We hypothesized that higher BMI is associated with increased cardiac index (CI) and reduced systemic vascular resistance (SVR), reflecting a hyperdynamic circulatory state.

Methods

This is a cross-sectional study of adults admitted to the Emergency Department at a large tertiary care hospital in Copenhagen, Denmark during 2019–2023. Patients were evaluated by physical examination and laboratory testing. Hemodynamic measurements, including CI and SVR, were estimated within 24 hours of admission using the non-invasive and continuous pulse wave analysis by Finapres® NOVA. The relationship between BMI, CI, and SVR were investigated using linear regression models.

Results

Of 942 participants (mean age 64 years; 44% female), 187 had obesity (BMI ≥ 30 kg/m²). Compared to participants without obesity, participants with obesity had 16% higher CI and 23% lower SVR (p < 0.0001). In linear regression models, BMI was positively associated with CI (p = 0.0001) and inversely with SVR (p = 0.0102). Each 5 kg/m² increase in BMI corresponded to a 7.7% rise in CI and a 12.7% decrease in SVR (p < 0.0001).

Conclusion

Higher BMI is significantly associated with increased CI and decreased SVR, indicating a hyperdynamic circulatory state in obesity. These findings suggest a potential hemodynamic mechanism linking obesity to cardiovascular risk.

Clinical trial registration

ClinicalTrials.gov (NCT03934775).

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Fig. 1
Fig. 2: Distribution of cardiac index and systemic vascular resistance across BMI groups.

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Data availability

The datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We extend our sincere appreciation to all individuals who contributed to this research. We are especially grateful to the participants who generously volunteered their time to take part in the study.

Funding

This study was conducted with support and funding from several research grants from Bispebjerg Hospital, a grant from the private fund “Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis’ Legat” and “Helsefonden”. The funders had no role in the design, collection, analysis, or interpretation of data. Nor did the funders have any role in the writing of the manuscript. All researchers were independent from the funders and no funder had access to the research data at any point in time.

Author information

Authors and Affiliations

  1. Department of Cardiology, Bispebjerg-Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark

    Emma H. J. Malm, Walid Warrad, Rakin Hadad, Helena Domínguez & Ahmad Sajadieh

  2. Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Ali Asmar, Helena Domínguez, Steen B. Haugaard & Ahmad Sajadieh

  3. Department of Clinical Physiology and Nuclear Medicine, Bispebjerg-Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark

    Ali Asmar

  4. Department of Endocrinology, Bispebjerg-Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark

    Steen B. Haugaard

Authors
  1. Emma H. J. Malm
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Contributions

EHJM drafted the manuscript, performed data analyses, and interpreted the results. WW conducted the literature, gathered materials essential for manuscript preparation, and interpreted results. RH secured funding, acquired data, conducted the clinical trial, performed data analyses, and provided supervision. AA contributed significantly to the interpretation of results and offered physiological insights to support the findings. HD provided supervision, assisted in interpreting the results, and made important contributions to the manuscript. SBH conceptualized the analysis and methodology, supervised the work, and interpreted the results. AS obtained funding, conceptualized the methodology and analysis, acquired data, conducted data analyses, and supervised the project. All authors made substantial contributions to revision of the manuscript and final approval of the version to be submitted and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Emma H. J. Malm.

Ethics declarations

Competing interests

HD has received support from her institution, Bispebjerg and Frederiksberg Hospital, to attend annual meetings of the Danish Society of Cardiology 2024 and 2025 and for Nordic-Baltic Cardiology Congress 2025. She is a member of the nucleus for the Digital Health working group within the Danish Society of Cardiology, and has received research compounds, as PI for the Librexia study, and received free-of-charge, devices for electrocardiogram recording with their analysis software from the company “HeartSciences”. The remaining authors declared no con-flict of interest.

Declaration of generative AI and AI-assisted technologies in the writing process

During the development of this work, OpenAI’s ChatGPT was used as a language support tool to help improve clarity and expression. All AI-assisted content was carefully reviewed, revised, and approved by the author(s), who take full responsibility for the final version of the publication.

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Malm, E.H.J., Warrad, W., Hadad, R. et al. Is hyperdynamic circulation a hallmark of obesity?. Int J Obes 50, 618–625 (2026). https://doi.org/10.1038/s41366-025-01981-5

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