Effects of obesity and weight changes on cardiac and vascular structure and function: does the clinical impact carry any weight?

SEE PAGES 489 AND 500 O verweight and obesity have increased in the United States and most of the Westernized world over recent decades, reaching a prevalence in the United States of well over 70% (1). Clearly, overweight and obese patients have increased cardiovascular (CV) risk factors, including hypertension, dyslipidemia, glucose abnormalities (impaired fasting glucose, metabolic syndrome, type II diabetes), and inflammation (1,2). Although a lack of physical activity is the primary cause of obesity (3–5), once obesity is manifest, physical activity and cardiorespiratory fitness progressively decline with weight gain. Therefore, it is not surprising that obesity is associated with a marked increased risk for most CV diseases. It is well known that obesity increases the risk for hypertension and coronary heart disease (CHD), which are leading causes of heart failure (HF) (2). Not surprisingly, the prevalence of HF is markedly increased in the setting of obesity, with progressive increases in HF prevalence correlating with increasing severity of obesity (2,6,7). Other related CV diseases (e.g., atrial fibrillation) are also more common in the setting of obesity (1,2).