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This scientific statement from the American Heart Association discusses the impact of obesity, including different forms of adiposity, on cardiovascular disease risk. The pathophysiology of coronary artery disease (CAD) in obesity is reviewed as well as CAD diagnosis, including the use of available noninvasive and invasive diagnostic tools. The clinical management and treatment of CAD in obesity is discussed, including lifestyle and surgical weight loss, PCI, antiplatelet therapy, and surgical revascularization. The pathophysiology of heart failure, arrhythmias, and sudden cardiac death in obesity are also discussed, including treatment options in these settings.
This statement highlights the impact of obesity on various cardiovascular diseases, reviews the diagnostic and treatment tools available for cardiovascular disease, and discusses areas of future research.
The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.
Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association
Circulation 2021 Apr 22;[EPub Ahead of Print], TM Powell-Wiley, P Poirier, LE Burke, JP Després, P Gordon-Larsen, CJ Lavie, SA Lear, CE Ndumele, IJ Neeland, P Sanders, MP St-Onge, American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council