Cardiovascular Prevention in Obese Patients

Background: The World Health Organization has emphasized that an increased body mass index (BMI) is a major risk factor for non-communicable diseases (NCDs) such as cardiovascular disease (CVD) together with diabetes, musculoskeletal disorders and some cancers. The American Heart Association had already identified obesity as an independent risk factor in 1995. There is a significantly increased risk of CVD independently of other traditional risk factors (age, sex, physical activity, smoking, blood pressure and cholesterol levels) for patients fulfilling BMI criteria of moderate overweight, which increases with the diagnosis of obesity. Thus, both overweight and obesity are major risk factors for type 2 diabetes (T2D), hypertension, and atherogenic dyslipidemia, among others. These diseases, when clustered, form the metabolic syndrome, a condition with exponential risk for CVD as compared with its isolated components. In this scenario, obesity emerges as a major public health challenge due to its huge clinical implications, taxing not only individuals but also health-care systems and society at large. Methods: The present review focuses on: i) the link between dysfunctional fat excess and CVD; ii) the apparent controversies surrounding the obesity paradox as well as the concept of metabolically healthy obesity; iii) the known beneficial effects following weight loss; and iv) available strategies to treat obesity in order to ameliorate cardiovascular risk, which include lifestyle interventions, drug therapy, endoscopic and surgical procedures. Conclusion: Obesity is a highly heterogeneous disease that requires customized recommendations. Weight loss in different degrees is attainable via diverse procedures reducing morbidity and mortality while improving psychological well-being and social function. Therapeutic strategies should be tailored to the patient's characteristics and need a long-term personal commitment to change.