The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox

Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):401-8. doi: 10.1016/j.pcad.2013.08.003. Epub 2013 Sep 27.


Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the ≪obesity paradox≫ in the secondary care of CHD patients and the CHD presentations where a paradox has been found. Finally we discuss the impact of cardiorespiratory fitness and a number of mechanisms which may offer potential explanations for this puzzling phenomenon.

Keywords: BF; BMI; CABG; CHD; CO; CRF; CV; Coronary heart disease; DM2; FFM; HDL-C; HF; HTN; Obesity; Obesity paradox; PCI; ST-segment elevation myocardial infarction; STEMI; TGs; US; United States; WC; WHR; body fat; body mass index; cardiorespiratory fitness; cardiovascular; central obesity; coronary artery bypass graft; coronary heart disease; diabetes mellitus type 2; fat-free mass; heart failure; high-density lipoprotein cholesterol; hypertension; percutaneous coronary intervention; triglycerides; waist circumference; waist-to-hip ratio.

Publication types

  • Review

MeSH terms

  • Body Mass Index*
  • Comorbidity
  • Coronary Disease / epidemiology*
  • Coronary Disease / physiopathology
  • Disease Progression
  • Female
  • Humans
  • Male
  • Obesity / epidemiology*
  • Obesity / physiopathology*
  • Obesity, Morbid / epidemiology
  • Obesity, Morbid / physiopathology
  • Prevalence
  • Prognosis
  • Risk Assessment
  • Survival Analysis