Obesity and Cardiovascular Disease: Current Knowledge

Obesity and cardiovascular disease (CVD) remain two of the most consequential noncommunicable diseases worldwide, contributing substantially to global morbidity and mortality. This narrative review synthesizes current evidence on the epidemiology, pathophysiological mechanisms, phenotypic variations, diagnostic assessments, and therapeutic strategies linking obesity and CVD. Global trends indicate a rapid increase in obesity prevalence across age groups, with corresponding rises in CVD incidence, particularly among women, children, and ethnic minorities. Obesity promotes cardiovascular risk through multiple interrelated pathways, including metabolic syndrome, insulin resistance, chronic inflammation, dysregulated adipokine secretion, atherogenic dyslipidemia, hemodynamic overload, and adverse cardiac remodeling. Emerging research highlights the importance of obesity phenotypes such as central adiposity, ectopic fat deposition, and metabolically healthy obesity in refining cardiovascular risk stratification beyond traditional metrics like BMI. Advances in imaging technologies and biomarker profiling have further enhanced noninvasive assessment of cardiometabolic risk. Evidence demonstrates that lifestyle modification remains the cornerstone of obesity management, although pharmacotherapy and bariatric surgery play critical roles in achieving meaningful and sustained weight loss in selected individuals. Special population considerations, including age, sex, ethnicity, and comorbidities such as diabetes, hypertension, and sleep disorders, underscore the heterogeneous nature of obesity-related CVD risk. Public health interventions that modify obesogenic environments, coupled with precision medicine approaches tailored to individual phenotypes, offer promising strategies for prevention. Despite substantial progress, significant knowledge gaps persist regarding long-term outcomes of emerging therapies, interactions between genetic predisposition and environmental exposures, and mechanisms underlying metabolically healthy obesity. Continued multidisciplinary research is essential to improve risk prediction, optimize clinical management, and reduce the growing global burden of obesity-related cardiovascular disease. Keywords: Obesity, Cardiovascular Disease, Metabolic Syndrome, Atherogenic Dyslipidemia, and Cardiometabolic Risk.