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JACC Journals › JACC › Archives › Vol. 81 No. 5
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Challenges in Cardiovascular Evaluation and Management of Obese Patients: JACC State-of-the-Art ReviewGET ACCESS

JACC State-of-the-Art Review

J Am Coll Cardiol. 2023 Feb, 81 (5) 490–504
Sections

Central Illustration

Abstract

Many unique clinical challenges accompany the diagnosis and treatment of cardiovascular disease (CVD) in people living with overweight/obesity. Similarly, physicians encounter numerous complicating factors when managing obesity among people with CVD. Diagnostic accuracy in CVD medicine can be hampered by the presence of obesity, and pharmacological treatments or cardiac procedures require careful adjustment to optimize efficacy. The obesity paradox concept remains a source of confusion within the clinical community that may cause important risk factors to go unaddressed, and body mass index is a misleading measure that cannot account for body composition (eg, lean mass). Lifestyle modifications that support weight loss require long-term commitment, but cardiac rehabilitation programs represent a potential opportunity for structured interventions, and bariatric surgery may reduce CVD risk factors in obesity and CVD. This review examines the key issues and considerations for physicians involved in the management of concurrent obesity and CVD.

Highlights

•

Obesity presents unique challenges to diagnosis and management of patients with known or suspected CVD.

•

Excess adiposity can impede the performance and reduce the accuracy of standard modalities for diagnosis of cardiovascular disease.

•

Weight reduction is an important adjunct to reduction of cardiovascular risk and management of CVD in obese patients, and when other measures are insufficient, bariatric surgery can improve outcomes.

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