Although there are multiple long-term deleterious health effects of excess weight, obesity as defined by BMI ≥30 kg/m2 is associated with premature atherosclerosis, increased risk of myocardial infarction and heart failure, and decreased survival, largely because of cardiovascular deaths, particularly in extreme weight categories.1,2 Factors that contribute to cardiovascular disease in obesity are multifactorial and include metabolic dysregulation with increased prevalence of atherogenic risk factors, including insulin resistance, hypertension, and dyslipidemia; adverse cardiac remodeling characterized by hypertrophy, chamber enlargement, and impaired ventricular systolic and diastolic function; vascular endothelial dysfunction; premature coronary artery disease; increased sympathetic tone; pulmonary hypertension with right-sided heart strain; and arrhythmias.3 Additionally, obesity is linked to a chronic state of inflammation evidenced by increased circulating levels of proinflammatory cytokines, derived largely from hepatic and adipose sources that may play roles in mechanisms of insulin resistance, plaque activation, myocardial hypertrophy, and cardiovascular disease progression. We recently observed that inflammatory changes in fat tissue are linked to systemic arterial dysfunction and abnormal clinical phenotypes, which suggests the possibility of a pathogenic adipose-cardiovascular axis.4 Although BMI is useful in predicting
