Abstract

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.