The Impact of Obesity on the Cardiovascular System

Abstract

Obesity is a growing health problem worldwide. It is associated with an increased cardiovascular risk on the one hand of obesity itself and on the other hand of associated medical conditions (hypertension, diabetes, insulin resistance, and sleep apnoea syndrome). Obesity has an important role in atherosclerosis and coronary artery disease. Obesity leads to structural and functional changes of the heart, which causes heart failure. The altered myocardial structure increases the risk of atrial fibrillation and sudden cardiac death. However, obesity also has a protective effect on the clinical outcome of underlying cardiovascular disease, the phenomenon called obesity paradox. The improved cardiac imaging techniques allow the early detection of altered structure and function of the heart in obese patients. In this review, we attempt to summarize the relationship between obesity and cardiovascular diseases and outline the underlying mechanisms. The demonstrated new techniques of cardiac diagnostic procedures allow for the early detection and treatment of subclinical medical conditions and, therefore, the prevention of cardiovascular events.

Figure 1

The pathomechanism of coronary artery disease in obesity.

Figure 2

The pathomechanism of heart failure in obesity.

Figure 3

The pathomechanism of atrial fibrillation in obesity.

Figure 4

Diagnosing diastolic dysfunction with echocardiography. Transmitral flow velocities measured with pulsatile wave Doppler technique. The ratio (E/A) of the early diastolic peak velocity (E) and the late diastolic velocity (A) is lower than 1. Deceleration time (DT) is the interval from the peak of the wave E to its end (marked with a yellow line). In this case, its prolongation was measured (310 sec). The above alterations prove the left ventricular diastolic dysfunction (relaxation disorder).