ESC Key Notes on Obesity and Cardiovascular Disease

European Society of Cardiology (ESC) Clinical Consensus Statement on Obesity and Cardiovascular Disease

Obesity affects about one in eight adults worldwide.
The prevalence of obesity has been rising over the past decades globally.
While marked obesity (BMI ≥35 kg/m2) is an emerging phenotype, most cases of obesity-related CVD are expected to arise from persons with BMI <35 kg/m2.
Preventive measures should focus particularly on childhood and early adulthood and address socioeconomic disparities.
Genetic and biological factors influence individual development of obesity, but the worldwide obesity epidemic is largely driven by environmental/societal factors.
Individuals with similar BMI may have different cardiometabolic risks.
Metrics of abdominal adiposity including waist circumference, waist-to-height ratio and waist-to-hip ratio are useful to refine cardiometabolic risk stratification beyond BMI.
Different imaging modalities can accurately assess fat topography and quality.
Quantification of perivascular, epicardial, and pericardial adipose tissue may improve CV risk assessment, but its clinical role remains uncertain.
Remote and local adipose tissue exert pro-atherogenic and pro-inflammatory effects on coronary vascular wall and myocardium, but may also shift to anti-atherogenic effects.
Overweight and obese individuals should regularly be screened for T2DM, particularly after age 45.
In patients with obesity and T2DM, hypertension, dyslipidemia, or OSA, reducing weight is a cornerstone of treatment.
Dietary interventions generally aim for a 500–750 kcal/day energy deficit. Adjustments to individual body weight and activity are needed.
Weight reduction in the range of 5%–10% can be achieved with various nutritional and multidisciplinary approaches but maintenance of effects is a key issue.
Physical activity interventions typically have modest effects on weight loss but are important for weight loss maintenance and reduction of overall CV risk.
GLP-1RAs are effective for weight loss and improvement in CV risk factors.
Currently, the only weight loss intervention with proven outcomes in patients with established CVD without T2DM is semaglutide 2.4 mg/weekly.
Treatment effects are limited to the duration of treatment. The long-term effects and maintenance of efficacy of weight loss medications requires further investigation.
Bariatric surgery should be considered for obese high-risk individuals when lifestyle change does not result in maintained weight loss (Class IIa, level of evidence B).
Bariatric surgery should be considered for high and very high-risk patients with T2DM and BMI ≥35 kg/m2 when repetitive and structured efforts of lifestyle changes combined with weight-reducing medications do not result in maintained weight loss (Class IIa, level of evidence B).