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Obesity is a major public health problem increasing risk for hypertension, diabetes mellitus, cardiovascular diseases, heart failure, stroke, left atrial enlargement and obstructive sleep apnoea. Conventionally, body mass index (BMI) is used in many studies to diagnose and classify obesity. However, epidemiological studies have shown that waist:hip ratio is a better predictor for myocardial infarction and sudden cardiac death compared with BMI. Nevertheless, some subjects who have ‘healthy obese phenotype’ have a benign cardiometabolic profile due to greater deposition of the fat tissue in the subcutaneous area rather than in the visceral area. Large clinical studies have confirmed ‘obesity survival paradox’ in patients with coronary artery disease and heart failure. ‘Sexual dimorphism’ is another interesting issue about obesity survival paradox that gender should be considered as an important confounding factor when investigating the correlation of obesity with cardiovascular diseases.1 ,2 These findings suggest that metabolic effects of adipose tissue may be different between males and females. It is well known that body fat mass is greater in females and the regional distribution …
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.