DR. CARBONE: First I’d like to point out that obesity is a major risk factor for cardiometabolic disease. There are significant data which show that if you have obesity, you have a high risk of developing coronary heart disease, heart failure, type 2 diabetes mellitus (T2DM) or risk factors such as hypertension and dyslipidemia.1
Several reports from epidemiologic studies, however, have demonstrated that once you have established cardiovascular disease, particularly coronary heart disease or heart failure, obesity can exert some degree of protection.2,3 This association is more pronounced for those with class I obesity (body mass index [BMI] between 30-35 kg/m2), which tend to have a better prognosis compared to normal weight (BMI of 18.5 – 25 kg/m2) and underweight individuals (BMI<18.5 kg/m2), but this benefit is less pronounced in patients with class II or severe obesity (when BMI is between 35-39.9 kg/m2, or ≥40 kg/m2). Early studies demonstrated that in ambulatory patients with advanced heart failure, overweight and obesity was not a risk factor for increased mortality, but rather it was associated with a trend towards improved survival compared to underweight or normal weight individuals.4 More recently, at least at the epidemiologic level, the obesity paradox has been confirmed in both heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), but also in those with coronary heart disease.5,6 So, it seems that once cardiovascular disease is present, then obesity may offer some degree of protection.
