CLINICAL REVIEW Obesity: Effects on Cardiovascular Disease and its Diagnosis

The higher prevalence of cardiovascular disease in obese individuals is indirectly mediated, to a large extent, by the increased frequency of various well known risk factors like hypertension, diabetes, and dyslipidemia, either individually or as part of the metabolic syndrome. However, there are several ways in which obesity directly affects the cardiovascular system; these will be discussed in detail. We also focus on various challenges posed by obesity in the performance and interpretation of cardiac investiga-tions and how they can be addressed. (J Am Board Fam Med 2008;21:562–8.) The incidence of obesity started growing to epi-demic proportions in the 1980s. Currently more than 30 % of the US population is obese (body mass index [BMI] 30) and nearly two thirds are over-weight (BMI between 25 and 29.9). These figures are expected to rise further if the current trend continues1–3 (see Table 14). There are 2 distinct genetic mechanisms involved in obesity. One is caused by the infrequent presence of certain genes