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Management of cardiovascular diseases in patients with obesity

Nature Reviews Cardiology volume 15, pages 45–56 (2018)Cite this article

Subjects

Key Points

  • People who are overweight or obese have more risk factors for cardiovascular disease (CVD), and are at increased risk of developing hypertension, coronary heart disease, heart failure, and atrial fibrillation

  • Patients with established CVD who are overweight or obese have a better prognosis than leaner patients with CVD, a phenomenon known as the 'obesity paradox'

  • The treatment of CVD among patients who are overweight or obese is associated with particular challenges and considerations

  • Despite the presence of the obesity paradox, substantial evidence still supports weight loss among patients with CVD who are obese, especially when associated with increases in physical activity and cardiorespiratory fitness levels

Abstract

The management of cardiovascular diseases (CVD) in patients with obesity presents numerous challenges. Obesity has a negative effect on almost all of the major CVD risk factors, and adversely influences cardiovascular structure and function. Patients who are overweight or obese have a higher incidence of almost all CVDs compared with patients who are of normal weight. However, those who are overweight or obese seem to have a better short-term and medium-term prognosis after major CVD events and interventional procedures or cardiac surgeries than leaner patients, a phenomenon termed the 'obesity paradox'. In considering the mechanisms underlying this paradox, we review evidence of the deleterious consequences of obesity in patients with coronary heart disease, and the limited data on the benefits of weight loss in patients with CVD. Additional studies are needed on the efficacy of purposeful weight loss on cardiovascular outcomes to determine the ideal body composition for patients with CVD.

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Figure 1: Mortality in patients undergoing percutaneous coronary intervention.
Figure 2: Three-year survival rates on the basis of body composition.
Figure 3: Combined effects of cardiorespiratory fitness and body composition.
Figure 4: BMI and mortality in patients with heart failure.
Figure 5: BMI and cardiorespiratory fitness levels.

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Acknowledgements

We thank Patricia Taylor (The John Ochsner Heart & Vascular Institute, New Orleans, USA) for preparing and submitting the manuscript and revisions.

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School – University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, 70121, Louisiana, USA

    Carl J. Lavie, Richard V. Milani & Hector O. Ventura

  2. Department of Physical Therapy, Department of Kinesiology and Nutrition, Integrative Physiology Laboratories, College of Applied Sciences, University of Illinois at Chicago, 1919 W Taylor Street, Chicago, 60612, Illinois, USA

    Ross Arena

  3. Division of Cardiovascular Medicine, University of Missouri School of Medicine, One Hospital Drive, Columbia, 65212, Missouri, USA

    Martin A. Alpert

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  1. Carl J. Lavie
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  2. Ross Arena
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  3. Martin A. Alpert
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  4. Richard V. Milani
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  5. Hector O. Ventura
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Contributions

C.J.L. and R.A. wrote the article. All authors contributed equally to researching data for the article, discussions of content, and to reviewing and editing of the manuscript before submission.

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Correspondence to Carl J. Lavie.

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Competing interests

C.J.L. is the author of the book 'The Obesity Paradox'. The other authors declare no competing interests.

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Lavie, C., Arena, R., Alpert, M. et al. Management of cardiovascular diseases in patients with obesity. Nat Rev Cardiol 15, 45–56 (2018). https://doi.org/10.1038/nrcardio.2017.108

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