A clinical consensus statement from the European Society of Cardiology highlighted the significant impact of obesity on cardiovascular disease and mortality.

In the report, presented at the European Society of Cardiology (ESC) Congress 2024 in London and co-published in the European Heart Journal and the European Journal of Preventive Cardiology, Investigators revealed that two-thirds of deaths related to high body mass index (BMI) were caused by cardiovascular disease (CVD).

According to the statement, the global prevalence of obesity had more than doubled over the past four decades, affecting over 1 billion individuals worldwide. In Europe alone, 23% of adults lived with obesity. The economic burden was substantial, with 7% of total national budgets across the European Union spent on noncommunicable diseases associated with obesity, a large proportion of which was related to CVD.

The report emphasized that patients with obesity had a 50% to 100% increased risk of all-cause mortality compared with patients with a normal weight, with 67.5% of this increased risk attributed to CVD.

Key findings from the report included:

• Obesity adversely affected various organs and was a direct risk factor for several CVDs, including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, independently of other CV risk factors.
• Individuals with a similar BMI could have different cardiometabolic risks. Other metrics of abdominal adiposity such as waist circumference, waist-to-height ratio, and waist-to-hip ratio, were useful to refine cardiometabolic risk stratification beyond BMI.
• Obesity and type 2 diabetes were strongly interrelated, with 80% to 85% of patients with type 2 diabetes being overweight or obese. Conversely, patients with obesity were nearly three times more likely to develop type 2 diabetes compared with patients with a normal weight (20% vs 7.3%, respectively).
• High BMI was responsible for 78% of the risk of hypertension in men and 65% of the risk in women aged 20 to 49 years.

The relationship between obesity and various types of CVD, including atrial fibrillation, atherosclerotic CVD, heart failure, arrhythmias, venous thromboembolism, and valvular disease was discussed in the Consensus Statement.

The report discussed comprehensive obesity treatment based on multidisciplinary approaches, including behavioral interventions, nutrition, physical activity, pharmacological therapy, and endoscopic procedures/bariatric surgery.

Regarding pharmacologic treatment, the statement highlighted that orlistat and bupropion/naltrexone should be used with caution because of their modest effects on body weight, limited evidence on CV safety, and concerns regarding potential long-term CV risk. However, glucagon-like peptide-1 receptor agonists, particularly semaglutide 2.4 mg/week, had proven effective in weight loss, improvement in CV risk factors, and CV outcomes among patients with established CVD without type 2 diabetes.

Please see full Consensus Statement for all disclosures.