The public health burden of sudden cardiac death (SCD) is high, accounting for about 50% of cardiovascular deaths, and resulting in more years of potential life lost than any single cancer.1 There is an established association between obesity and SCD2 ,3 which has attained increased importance due to the burgeoning global rise in the proportion of overweight and obese individuals. In the USA, obesity has reached epidemic proportions. A third of the population is obese, with median body mass index (BMI) above 27 kg/m² and age-adjusted obesity prevalence above 35% for both sexes.4

Obesity appears to drive overall cardiovascular morbidity and mortality largely by its link to cardiovascular risk factors including diabetes, total cholesterol, low density lipoprotein, and hypertension. Traditionally, BMI has been used in analyses of obesity and outcomes, but there is a growing literature suggesting that the distribution of body fat is important in determining cardiovascular disease (CVD) risk. In particular, abdominal adiposity appears to confer a higher risk for CVD than obesity in general.5