Obesity Paradox in Cardiovascular Diseases and Research Progress

The World Health Organization has defined overweight and obesity based on body mass index (BMI; weight in kilograms/height in meters squared, kg/m2). The prevalence of overweight and obesity as defined by BMI is rapidly increasing, particularly in children and adolescents, and associated with significantly increased risk of CVDs at an earlier age [1]. There is scientific consensus that obesity increases the risk of CVDs, excessive body weight associated with negative effects on hemodynamics, cardiac morphology and ventricular function, even metabolically healthy obese individuals had a higher risk for coronary heart disease [2,3]. It seems different from what we imagined, despite this negative correlation, recent epidemiological data and numerous studies found that overweight and obese people with established CVDs appear to have a better clinical prognosis. It is necessary for us to face up to this problem, because it may affect our diagnosis and treatment of patients. Is patients with CVDs fatter really fitter?