Studies indicate that obesity as such not only relates to but independently predicts coronary atherosclerosis.

This relation appears to exist for both men and women with minimal increases in body mass index (BMI). In a 14-year prospective study, middle-aged women with a BMI greater than 23 but less than 25 had a 50% increase in risk of nonfatal or fatal coronary heart disease.

Men aged 40 to 65 years with a BMI greater than 25 but less than 29 had a 72% increased risk.¹⁶

Left ventricular hypertrophy is common in patients with obesity and to some extent is related to systemic hypertension.²⁰ However, abnormalities in left ventricular mass and function also occur in the absence of hypertension²and may be related to the severity of obesity.

Hypertension is approximately three times more common in obese than normal-weight persons.

However, in obese patients without hypertension, increases in stroke volume and cardiac output as well as diastolic dysfunction are seen. These changes in the left ventricle are related to sudden death in obese patients.

Changes in the right heart also occur in obesity. The pathophysiology is related to obstructive sleep apnea and/or the obesity hypoventilation syndrome, which produce pulmonary hypertension and right ventricular hypertrophy, dilatation, progressive dysfunction, and finally failure.

In patients with congestive heart failure, sodium restriction and small reductions in weight may dramatically improve ventricular function and oxygenation.³ In addition, several studies suggest that the more extensive weight reduction that follows gastrointestinal surgery for obesity reduces cardiovascular mortality. Weight reduction appears useful in reducing risks of coronary heart disease and congestive heart failure and potentially preventing heart disease in obese patients.

Treatment of obesity should be based on its severity and the presence of comorbidities, eg, congestive heart failure, dyslipidemia, hypertension, non–insulin dependent diabetes, and obstructive sleep apnea.

Prevention of obesity by diet and regular physical activity remains the highest priority for maintaining cardiovascular health. This is particularly important for small children and adolescents.

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