Impact of obesity on outcomes in myocardial infarction combating the "obesity paradox".

Overweight and obesity are increasing in epidemic proportions both in the United States and throughout the world (1). Alarmingly, the proportion of patients with severe and morbid obesity is increasing even more so than are overweight and obesity per se. Almost all of the major coronary heart disease (CHD) risk factors, including lipid disorders (especially elevated triglycerides and low levels of highdensity lipoprotein cholesterol), glucose abnormalities, the metabolic syndrome, and diabetes mellitus, hypertension or left ventricular hypertrophy, and physical inactivity, are all adversely affected by overweight and obesity. Additionally, overweight and obesity may be independent risk factors for CHD and have adverse impacts on other cardiovascular (CV) disorders that may accompany CHD, including heart failure (HF), atrial fibrillation, and risk for sudden cardiac death (1).