7 Although BMI is strongly correlated with percent body fat across populations, there are limitations in its predictive ability to estimate body fat for any given individual, 10–12 with considerable variation by sex, age, and race/ethnicity. 6–8 The “2013 AHA /ACC /TOS Guideline for the Management of Overweight and Obesity in Adults” 7 uses the World Health Organization criteria 9 to define overweight as a body mass index (BMI) ≥25 and <30 kg/m 2 and obesity as a BMI ≥30 kg/m 2. Obesity is a multifactorial disease with a complex pathogenesis related to biological, 1 psychosocial, 2 socioeconomic, 3 and environmental 4, 5 factors and heterogeneity in the pathways and mechanisms by which it leads to adverse health outcomes. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. 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 contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity.
More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.
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