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Association Between Obesity and Cardiovascular Outcomes: Updated Evidence from Meta-analysis Studies

Current Cardiology Reports volume 22, Article number: 25 (2020) Cite this article

Abstract

Purpose of Review

The prevalence of obesity and cardiovascular disease (CVD) has been increasing worldwide. Studies examining the association between adiposity and CVD outcomes have produced conflicting findings. The interplay between obesity and CVD outcomes in the general population and in specific subpopulations is complex and requires further elucidation.

Recent Findings

We report updated evidence on the association between obesity and CVD events through a review of meta-analysis studies. This review identified that obesity or high body mass index (BMI) was associated with an increased risk of CVD events, including mortality, in the general population and that cardiac respiratory fitness (CRF) and metabolic health status appear to stratify the risk of CVD outcomes. In patients with diabetes, hypertension, or coronary artery disease, mortality displayed a U-shaped association with BMI. This U-shaped association may result from the effect of unintentional weight loss or medication use. By contrast, patients with other severe heart diseases or undergoing cardiac surgery displayed a reverse J-shaped association suggesting the highest mortality associated with low BMI. In these conditions, a prolonged intensive medication use might have attenuated the risk of mortality associated with high BMI.

Summary

For the general population, a large body of evidence points to the importance of obesity prevention and maintenance of a healthy weight. However, for those with diagnosed cardiovascular diseases or diabetes, the relationship between BMI and cardiovascular outcomes is more complex and varies with the type of disease. More studies are needed to define how heterogeneity in the longitudinal changes in BMI affects mortality, especially in patients with severe heart diseases or going under cardiac surgery, in order to target subgroups for tailored interventions. Interventions for managing body weight, in conjunction with improving CRF and metabolic health status and avoiding unintentional weight loss, should be used to improve CVD outcomes.

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Affiliations

  1. Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA

    Alok Kumar Dwivedi

  2. Department of Obstetrics & Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Avenue, El Paso, TX, 79905, USA

    Pallavi Dubey & Sireesha Y. Reddy

  3. Center of Emphasis in Diabetes & Metabolism, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA

    David P. Cistola

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Conflict of Interest

Alok Kumar Dwivedi, Pallavi Dubey, and Sireesha Y. Reddy declare that they do not have any conflict of interest.

David P. Cistola reports a grant from the US NIH/National Heart Lung and Blood Institute, R21 HL143030. In addition, Dr. Cistola has three broadly relevant patents and patent applications: (1) “Methods for Monitoring Changes in the Core of Lipoprotein Particles in Metabolism and Disease,” U.S. utility patent, issued January 24, 2017, as US patent number 9,551,768. Assignee: East Carolina University, Inventors: Cistola, David P.; Robinson, Michelle D; (2) “Methods and Tools for Diagnosing Insulin Resistance and Assessing Health Status Using NMR Relaxation Times for Water.” U.S. provisional patent 62/13,112. Filed February 6, 2015; PCT patent PCT/US2016/016906, filed February 6, 2016. Published, 8/11/2016; U.S. non-provisional patent 15/548,442, filed 8/3/2017, published 1/25/2018. Assignee: University of North Texas Health Science Center, Fort Worth Inventors: Cistola, David P.; Robinson, Michelle D., patent pending; and (3) “Method and System for Non-invasive Measurement of Metabolic Health.” U.S. non-provisional patent application no. 15/911,728, filed 3/5/2018; published 9/5/2019 as US 2019/0271749 A1. Assignee: Texas Tech University Inventors: Cistola, David P.; Patel, Vipulkumar, patent pending.

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Dwivedi, A.K., Dubey, P., Cistola, D.P. et al. Association Between Obesity and Cardiovascular Outcomes: Updated Evidence from Meta-analysis Studies. Curr Cardiol Rep 22, 25 (2020). https://doi.org/10.1007/s11886-020-1273-y

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Keywords

  • Cardiovascular disease
  • All-cause mortality
  • Obesity
  • Overweight
  • Heart disease
  • Body mass index