Obesity and the heart: redefinition of the relationship

Although obesity is an important cardiovascular risk factor, growing evidence shows that obesity is not always related to an unfavourable cardio-metabolic profile or poor cardiac outcomes. Recent studies show that excess fat even in the absence of comorbidities (uncomplicated obesity) can lead to adaptive cardiac morphological and functional changes. Uncomplicated obesity represents a well-defined clinical entity that should be carefully considered and followed up. The existence of metabolically healthy subjects presenting a lower prevalence of cardiac modifications and risk factors strongly suggests that a redefinition of obesity based on regional fat distribution indices like waist-to-hip ratio instead of body mass index is warranted.