Obesity is a raging epidemic with a significant impact on cardiovascular health profile. It harbingers the development of both structural [coronary artery disease (CAD), heart failure (HF)] and electrical (atrial fibrillation) cardiac disorders. On a background of low-grade chronic inflammation, the changes in body composition, hemodynamic alterations, and myocardial fat deposition accelerate the associated cardiovascular morbidity. Quite counterintuitively, obese patients having CAD or HF fare better than their normal-weight counterparts; a phenomenon described as the “obesity paradox”. An increase in lean mass (LM) and consequent improvement in cardiorespiratory fitness (CRF), partly explains this phenomenon. In the following review, we aim to decipher the links between obesity and cardiovascular diseases (CVDs) along with the evolving concept of “adiposopathy” and current evidence shedding light on the intriguing “obesity paradox”. The significance of estimating and improving CRF is also discussed along with current recommendations for managing obesity.
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