Obesity Effects on Cardiovascular Outcomes
Summary
Obesity, defined by excess adiposity, is a major global risk factor for cardiovascular disease, driving the development of hypertension, dyslipidaemia and insulin resistance. Excess body weight contributes to structural and functional cardiac remodelling, pro-inflammatory states and endothelial dysfunction, thereby increasing the incidence of coronary artery disease, heart failure and stroke. Paradoxically, observational cohorts of patients with established cardiovascular events have sometimes shown lower mortality in those with overweight or class I obesity compared with normal‐weight groups, a phenomenon termed the “obesity paradox.” This effect appears most pronounced in acute coronary syndromes and after revascularisation procedures, though it diminishes in extreme obesity. Heterogeneity in fat distribution, muscle mass and the intensity of post-event medical therapy may account for these observations. The global rise in obesity prevalence has prompted renewed focus on stratifying cardiovascular risk by both body mass index and measures of central adiposity, and on personalised approaches to weight management and pharmacological support after myocardial infarction or percutaneous interventions.
Research from Nature Portfolio
Recent studies have explored sex-specific effects of mild obesity on outcomes following ST-segment elevation myocardial infarction. In a large cohort undergoing percutaneous coronary intervention, mildly obese men exhibited a significantly lower composite rate of death and recurrent events compared with non-obese men, after adjustment for age and comorbidities. This protective association was not observed in female patients, suggesting that sex differences in adipose distribution, inflammatory response and metabolic reserve may underlie divergent prognoses. These findings reinforce the concept that moderate adiposity may confer resilience against the stress of acute infarction in certain subgroups, while emphasising the need for sex-tailored risk assessment and post-infarction management strategies.
Obesity Effects on Cardiovascular Outcomes publication trend
The graph below shows the total number of articles in obesity effects on cardiovascular outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Obesity paradox: Observation that overweight or mildly obese patients with established cardiovascular disease sometimes exhibit lower mortality rates than normal-weight patients.
Body mass index (BMI): A measure of body fat calculated as weight in kilograms divided by height in metres squared.
Percutaneous coronary intervention (PCI): A minimally invasive procedure to open narrowed coronary arteries using balloon angioplasty and stenting.
ST-segment elevation myocardial infarction (STEMI): A severe form of heart attack characterised by persistent elevation of the ST segment on an electrocardiogram.
Hazard ratio (HR): A measure of effect in survival analyses that compares the hazard rates between two groups over time.
Waist circumference (WC): An anthropometric measure of abdominal fat, often used to assess central obesity and cardiometabolic risk.
References
- The obesity paradox in acute coronary syndrome: a meta-analysis. European Journal of Epidemiology (2014).
- Prolonged and intensive medication use are associated with the obesity paradox after percutaneous coronary intervention: a systematic review and meta-analysis of 12 studies. BMC Cardiovascular Disorders (2016).
- Sex-specific impact of mild obesity on the prognosis of ST-segment elevation myocardial infarction. Scientific Reports (2024).
- Association of Body Mass Index and Extreme Obesity With Long‐Term Outcomes Following Percutaneous Coronary Intervention. Journal of the American Heart Association (2019).
- Obesity Impacts Mortality and Rate of Revascularizations Among Patients With Acute Myocardial Infarction: An Analysis of the National Inpatient Sample. Cureus (2020).
- Relationship of body mass index and waist circumference with clinical outcomes following percutaneous coronary intervention. PLOS ONE (2018).
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