Body fat and cardiovascular risk: understanding the obesity paradox

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Abstract
Large studies of initially healthy men and women consistently link adiposity with an increased risk of cardiovascular events.1,2 Compared with a reference body mass index (BMI) 2, the relative risk of dying during the next decade ranges from 1.2 for overweight (25–29.9 kg/m2) to 3.8 for severely obese (≥40 kg/m2) subjects, after adjustment for age, smoking, alcohol, and physical activity.1 Abdominal fat, measured as the waist–hip ratio, more reliably predicts the risk of ischaemic heart disease and death than BMI, even within normal body weights and after additional adjustment for blood pressure and cholesterol.2,3

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