Purpose of review

Obesity, generally defined by body mass index (BMI), is an established risk factor for the development of cardiovascular disease (CVD), while cardiorespiratory fitness (CRF) decreases risk. In chronic CVD, an obesity survival paradox in which higher BMI is associated with improved prognosis has been reported. This paper will examine the effect of obesity on CVD risk, explore obesity as a risk factor in patients with established CVD, and investigate the relationship between CRF, obesity, and CVD.

Recent findings

Through metabolic and hemodynamic changes, obesity increases the risk for CVD and contributes to the development of other cardiovascular risk factors such as diabetes, dyslipidemia, and hypertension. Obesity is associated with metabolic, hormonal, and inflammatory changes that leads to atherosclerosis increasing the risk for coronary artery disease, and myocardial remodeling increasing the risk for heart failure. However, it has also been observed that overweight/obese patients with established CVD have a better prognosis when compared to non-obese individuals termed the obesity paradox. CRF is a vital component of health associated with improved cardiovascular outcomes and furthermore has been shown to markedly attenuate or nullify the relationship between obesity and CVD risk/prognosis. Increasing CRF mitigates CVD risk factors and improves overall prognosis in CVD regardless of obesity status.

The current economic burden of cardiovascular (CV)-related hospitalizations grouped by diagnoses and procedures in the United States has not been well characterized. The objective was to identify current trends in CV-related hospitalizations, procedural utilization, and health care costs using the most recent 6 years of hospitalization data. A retrospective analysis of discharge data from the National Inpatient Sample database was conducted to determine trends in CV-related hospitalizations, costs, and procedures for each year from 2016 to the most recent available dataset, 2021. Total CV-related costs were adjusted to and reported in 2023 dollars. In 2021, there were 4,687,370 CV-related hospitalizations at a cost of $108 billion. Heart failure hospitalizations accounted for the highest costs at $18.5 billion, followed by non-ST-elevation myocardial infarction at $11.2 billion and stroke at $10.9 billion. Significant upward trends in costs from 2016 to 2021 were observed for heart failure, stroke, atrial fibrillation, ST-elevation myocardial infarction, chest pain, hypertensive emergency, ventricular tachycardia, aortic dissection, sudden cardiac death, pericarditis, supraventricular tachycardia, and pulmonary heart disease. Over the 6 observational years, total costs increased by over $10 billion, representing a 10% increase. However, the increases were not linear, as there was a significant increase of 6.5% from 2018 to 2019, then a decrease of over 7% from 2019 to 2020, followed by an increase of approximately 6% from 2020 to 2021. By 2030, total CV-related costs are projected to reach $131.3 billion. For all years, coronary procedures were the most performed, followed by extracorporeal membrane oxygenation, non-bypass peripheral vascular surgery, pacemaker placement, and coronary artery bypass graft surgery. Both transcatheter aortic valve replacement and MitraClip procedures demonstrated significant upward trends from 2016 to 2021. Overall, from the years 2016 to 2021, CV-related hospitalizations, costs, and procedures demonstrated upward trends. In conclusion, CV disease remains a high burden in the hospital setting with tremendous health care costs.