DefinePK

Abstract

Objective: Obesity is a well-established risk factor for ischemic heart disease (IHD. However, the “obesity paradox” suggests that overweight and obese patients may experience lower short-term mortality following acute cardiovascular events compared to normal-weight individuals. This paradox complicates clinical risk stratification and challenges quality improvement (QI) efforts aimed at optimizing cardiovascular outcomes in obese patients. This study aims to evaluate obesity-related IHD outcomes and propose a structured QI approach for obesity-integrated cardiovascular care.
Methodology: A literature review was conducted to examine the relationship between body mass index (BMI) and outcomes in patients with IHD, including those undergoing acute myocardial infarction management, coronary revascularization, transcatheter edge-to-edge repair, and anticoagulation for atrial fibrillation. Studies evaluating the obesity paradox and its implications for QI interventions were analyzed.
Results: Evidence indicates that morbid obesity (BMI ≥40 kg/m²) is associated with increased cardiovascular complications, including venous thromboembolism, heart failure, and arrhythmias. A J-shaped mortality curve is observed, with the highest mortality risk in underweight and morbidly obese patients. However, overweight and moderately obese patients consistently demonstrate lower in-hospital mortality after MI and coronary procedures compared to normal or underweight patients. The obesity paradox is evident across multiple cardiovascular conditions, including patients receiving oral anticoagulation for atrial fibrillation, but morbid obesity is linked to worse long-term survival. Underweight patients experience the highest mortality risk, highlighting the complex relationship between BMI and outcomes.
Conclusion: Obesity presents distinct challenges in IHD management, necessitating targeted QI strategies. These include BMI-specific treatment protocols, enhanced cardiac rehabilitation programs tailored for obese patients, and structured lifestyle interventions. Incorporating obesity-focused risk assessment into clinical pathways may optimize outcomes. Public health policies promoting early detection and weight management can reduce IHD burden. Future research is needed to refine BMI-adjusted care models and address the long-term impact of obesity on cardiovascular health.