ABSTRACT
Obesity has increased in epidemic proportions in the United States and much of the Westernized world. Obesity has adverse effects on most cardiovascular disease (CVD) risk factors, including worsening dyslipidemia, blood pressure, and blood sugar, leading to metabolic syndrome, type 2 diabetes mellitus, and increasing inflammation. This may result in dramatic increases in CVD, especially heart failure (HF) primarily with preserved rather than reduced ejection fraction, atrial fibrillation, hypertension, and coronary heart disease. Clearly, CVD morbidity and mortality are increased in patients with obesity. However, in patients with established CVD, an obesity paradox is present, where patients with overweight and at least mild obesity with CVD tend to have a better short- and medium-term prognosis than do their leaner counterparts with the same CVD. Physical activity (PA) and cardiorespiratory fitness (CRF) markedly alter the obesity paradox and have a strong impact on subsequent prognosis and CVD- and all-cause survival. Significant efforts are needed to improve PA, exercise, and CRF, and to prevent obesity and its progression in the primary and secondary prevention of CVD.
