Targeting abdominal obesity in cardiology: can we be effective?

Obesity has reached epidemic proportions in much of the industrialized world, and is also increasing in prevalence in the developing world. In the later decades of the 20th century until present, there have been numerous epidemiological studies reporting the relationship between excess weight and total, or all-cause, mortality. Obesity is associated with a wide variety of comorbidities such as type 2 diabetes, systemic hypertension, cardiovascular disease, certain cancers and sleep apnea, most of which may lead to disability or death. In general, the risk of developing comorbidities such as diabetes and cardiovascular disease rises as body mass index (BMI) increases. Using BMI, an indicator of relative weight for height (kg/m(2)) and a frequently used surrogate for assessing excess body fat, epidemiological studies have found linear, U- or J-shaped relationships between total mortality and BMI. However, obesity is remarkably heterogeneous. Obese patients considered to be 'at risk' are mostly characterized by features associated with the metabolic syndrome. The aim of the present paper is to review the cardiovascular consequences of obesity and to review some of the literature emphasizing why the cardiologist should measure other indices of adiposity in order to refine clinical assessment of obese individuals.