Challenges in Cardiovascular Evaluation and Management of Obese Patients: JACC State-of-the-Art Review

Rosana G. Bianchettin, Carl J. Lavie, Francisco Lopez-Jimenez

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)490-504
Number of pages15
JournalJournal of the American College of Cardiology
Issue number5
StatePublished - Feb 7 2023


  • body composition
  • body mass index
  • cardiovascular disease
  • obesity
  • obesity paradox
  • weight loss

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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