In patients with cardiovascular disease, both clinicians and patients struggle with the issue of obesity as related to cardiometabolic syndrome and recurrent cardiovascular events. In a prospective study of 5231 patients with cardiovascular disease but no history of diabetes, Dr. van der Leeuw and colleagues defined cardiometabolic dysfunction as 3 or more of the following: elevated blood pressure, high serum triglycerides, low high density lipoprotein, elevated fasting glucose or an elevated C-reactive protein level. Adiposity was defined by body mass index (BMI) as normal weight, overweight or obese. The risk of recurrent cardiovascular events was higher in patients with cardiometabolic syndrome in all three BMI categories whereas BMI alone was not a predictor of adverse cardiovascular outcomes (figure 1).

The controversy surrounding the relative role of obesity versus physiologic changes associated with obesity as a cardiovascular risk factor is concisely summarized in an editorial …