Clinical Report: Cardiovascular Disease and Obesity – ESC Clinical Consensus

Overview

Obesity, affecting over a billion individuals globally, is a major risk factor for cardiovascular disease (CVD), accounting for two-thirds of obesity-related excess mortality. This ESC clinical consensus highlights the epidemiology, pathophysiology, and management strategies for obesity to reduce cardiovascular risk and improve outcomes.

Background

Obesity is a complex, multifactorial disease characterized by excess body fat accumulation and has reached epidemic proportions worldwide. It is causally linked to numerous chronic conditions, notably cardiovascular diseases including atherosclerosis, heart failure, arrhythmias, and sudden cardiac death. The World Health Organization and European Commission have recognized obesity as a disease due to its impact on quality of life and life expectancy. Despite its significance, obesity remains underrecognized and undertreated compared to other modifiable cardiovascular risk factors.

Data Highlights

A meta-analysis involving over 10 million individuals demonstrated a log-linear increase in all-cause mortality with body mass index (BMI) values above 25 kg/m2. Approximately 67.5% of deaths related to high BMI are attributable to cardiovascular disease. The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than one billion people worldwide.

Key Findings

• Obesity directly contributes to cardiovascular risk factors such as type 2 diabetes mellitus, dyslipidaemia, and hypertension.
• It adversely affects cardiac structure and function, leading to both atherosclerotic and non-atherosclerotic cardiovascular diseases independently of other risk factors.
• Two-thirds of obesity-related excess mortality is due to cardiovascular disease.
• Obesity is underrecognized and sub-optimally managed compared to other modifiable cardiovascular risk factors.
• Comprehensive management includes lifestyle interventions, pharmacological therapies, and bariatric procedures tailored to individual patient needs.
• Population-based and personalized prevention strategies are essential starting from early childhood to reduce obesity prevalence and related cardiovascular complications.

Clinical Implications

Clinicians should prioritize early identification and comprehensive management of obesity as a major cardiovascular risk factor. Integrating multidisciplinary approaches including lifestyle modification, pharmacotherapy, and surgical options can improve cardiometabolic risk profiles and cardiac outcomes. Awareness and implementation of evidence-based obesity prevention and treatment strategies are critical in both primary and secondary cardiovascular disease prevention.

Conclusion

Obesity is a major, modifiable contributor to cardiovascular disease and mortality. Addressing obesity through evidence-based, multidisciplinary interventions is essential to reduce the global cardiovascular disease burden and improve patient outcomes.

References

1. European Society of Cardiology (ESC) Clinical Consensus Statement 2024 -- Cardiovascular Disease and Obesity