What are the risks for cardiovascular events in people who are overweight and obese?
In a meta-analysis of 21 cohort studies including 300,000 persons, the risks for cardiovascular events in patients who were overweight (BMI 25-29.9) and obese (BMI ≥30) compared with those of normal weight were 32% and 81% higher, respectively, after adjustment for age, sex, physical activity, and smoking. Cardiovascular risk is increased particularly in patients with central obesity, which can be identified by a waist circumference ≥102 cm (40 inches) in men or ≥88 cm (35 inches) in women, and in those with extreme obesity, defined as a BMI ≥40 kg/m2. Obesity likely contributes to increased cardiovascular risk through multiple pathophysiological pathways, such as traditional cardiovascular risk factors, such as diabetes mellitus, dyslipidemia, and hypertension, but in and of itself obesity increases sympathetic tone, induces a hyper-coagulable state, and is associated with markers of inflammation.