Is Obesity a Risk Factor for Cardiovascular Disease?

This article reviews research on the relationship between cardiovascular disease (CVD) and obesity. A preponderance of evidence strongly suggests that obesity is causally related to elevated blood pressure, elevated cholesterol, and glucose intolerance, all of which are primary risk factors for CVD. Nevertheless, data linking obesity to CVD itself are less consistent. While some studies show a positive and graded relationship between obesity and CVD incidence and mortality, others show no effect or even an inverse relationship. Possible reasons for these conflicting findings are discussed. These include heterogeneity of obesities, particularly central versus peripheral obesity; misclassification of individuals due to use of inaccurate obesity indices; analytic difficulties in estimating the contributions of obesity as a single variable in a complex chain of causation; and the presence of confounders such as cigarette smoking that lower weight, but are themselves a cause of CVD.