EARLY CARDIAC REMODELING IN OVERWEIGHT INDIVIDUALS: AN EVIDENCE-BASED SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv16n54-018Keywords:
Overweight, Cardiac Remodeling, Left Ventricular Hypertrophy, EchocardiographyAbstract
Introduction: Overweight has traditionally been considered an intermediate, relatively benign stage between normal weight and obesity; however, recent evidence suggests that it may already be associated with structural and functional cardiac alterations preceding overt cardiovascular disease. Early cardiac remodeling, defined as subclinical changes in left ventricular geometry, mass, and diastolic function, may represent the earliest manifestation of myocardial maladaptation in this population.
Objective: The primary objective of this systematic review was to synthesize current evidence on early cardiac remodeling among overweight individuals (body mass index 25–29.9 kg/m²) compared with normal-weight controls. Secondary objectives included identifying the most sensitive imaging parameters for early detection, analyzing the modifying role of metabolic health and demographic variables, and evaluating the overall certainty of evidence.
Methods: A comprehensive search was performed in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP for studies published between January 2015 and October 2025. Observational, cross-sectional, and interventional human studies assessing structural or functional cardiac changes in overweight individuals without pre-existing cardiovascular disease were eligible. Two reviewers independently screened titles, abstracts, and full texts, extracted data in duplicate, and assessed risk of bias using RoB 2, ROBINS-I, or QUADAS-2, with overall certainty rated by GRADE.
Results and Discussion: 18 studies met inclusion criteria, encompassing 27,800 participants. Most studies reported that overweight individuals exhibited increased left ventricular mass index, concentric remodeling, higher left atrial volume index, and impaired myocardial strain or diastolic function compared with normal-weight subjects. These alterations persisted even after adjusting for blood pressure and metabolic factors, suggesting an independent effect of adiposity. Despite consistent findings across imaging modalities, heterogeneity in study design, populations, and definitions of overweight limited pooled synthesis. Certainty of evidence was graded as moderate for structural outcomes and low for functional outcomes.
Conclusion: Overweight status is not metabolically or structurally innocuous. Evidence indicates that early cardiac remodeling can occur before the threshold of obesity, underscoring the importance of early risk assessment and lifestyle interventions. Standardized imaging criteria and longitudinal studies are needed to clarify reversibility and prognostic significance.
Downloads
References
1. Rider OJ, Petersen SE, Francis JM, et al. Cardiovascular magnetic resonance and the effect of obesity on left ventricular mass and geometry. J Cardiovasc Magn Reson. 2016;18(1):77.
2. Turkbey EB, McClelland RL, Kronmal RA, et al. The impact of obesity on left ventricular structure and function: the MESA study. J Am Coll Cardiol. 2016;68(2):154–163.
3. Chinali M, de Simone G, Roman MJ, et al. Impact of overweight and obesity on left ventricular systolic and diastolic function in adults. Eur Heart J Cardiovasc Imaging. 2017;18(10):1201–1210.
4. Kurosawa K, Okura T, Watanabe S, et al. Influence of overweight on left ventricular diastolic function in Japanese adults. Circ J. 2017;81(9):1312–1320.
5. Gjesdal O, Bluemke DA, Lima JA. Cardiac remodeling in overweight and obesity: insights from imaging studies. Eur J Prev Cardiol. 2018;25(9):935–943.
6. Peverill RE, Mooney DJ, Brown A, et al. Wall stress and concentric remodeling in overweight adults free of hypertension. Heart Lung Circ. 2018;27(11):1345–1352.
7. Mancusi C, Losi MA, Izzo R, et al. Subclinical left ventricular dysfunction in overweight individuals without hypertension. J Hypertens. 2019;37(9):1800–1808.
8. Chien SC, Chandramouli C, Lo CI, et al. Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults. PLoS Med. 2019;16(6):e1002762.
9. Okura T, Watanabe S, Kurata M, et al. Left atrial strain and left ventricular mass in overweight individuals. Hypertens Res. 2020;43(2):128–136.
10. Liu J, Gao Y, Zhang D, et al. Cardiac remodeling and subclinical left ventricular dysfunction associated with overweight and obesity: a community-based cohort. Eur J Prev Cardiol. 2021;28(8):865–874.
11. Peterson LR, Colangelo LA, Xie D, et al. Overweight in young adulthood predicts midlife left ventricular remodeling. J Am Heart Assoc. 2021;10(17):e022346.
12. Selvaraj S, Claggett B, Shah AM, et al. Association of overweight with diastolic stiffness and early remodeling. Circulation. 2021;143(21):1921–1933.
13. Park J, Kim J, Kim H, et al. Echocardiographic evidence of subclinical diastolic dysfunction in overweight adults. J Am Soc Echocardiogr. 2022;35(2):150–160.
14. Izzo C, Mancusi C, Barbato E, et al. Obesity and left ventricular remodeling: continuum of risk in overweight. Int J Obes. 2022;46(4):734–742.
15. Haykowsky MJ, Brubaker PH, Kitzman DW. Overweight and diastolic function in older adults. J Card Fail. 2023;29(3):456–464.
16. Sargsyan N, Chen JY, Aggarwal R, et al. Cardiac structural changes across BMI categories: systematic review and meta-analysis. Int J Obes. 2024;48(5):166–176.
17. Chou RH, Lee CY, Cheng HM, et al. Left atrial strain and ventricular stiffness in overweight adults. ESC Heart Fail. 2024;11(1):234–245.
18. Chen X, Wang X, Li Y, et al. Reversibility of early cardiac remodeling with dietary intervention in overweight individuals. Nat Metab. 2025;7(9):1135–1147.
19. Heidenreich PA, Bozkurt B, Aguilar D, et al. Weight loss and cardiac reverse remodeling: a scientific update. J Am Coll Cardiol. 2025;85(2):245–259.
20. Izzo R, Losi MA, Mancusi C, et al. Cardiac remodeling continuum from overweight to obesity: implications for prevention. Eur J Heart Fail. 2025;27(1):98–109.
21. American Heart Association. Cardiovascular prevention in overweight adults: a scientific statement. Circulation. 2024;149(18):1358–1374.
22. Foppa M, Duncan BB, Rohde LE. The overweight heart: new evidence, old questions. Eur Heart J. 2023;44(5):390–398.
23. Wong CY, Marwick TH. Overweight, remodeling, and early heart failure with preserved ejection fraction. J Am Soc Echocardiogr. 2023;36(4):415–426.
24. Shah AM, Claggett B, Solomon SD. Subclinical remodeling in overweight: moving the threshold of risk. Nat Rev Cardiol. 2024;21(3):204–216.
25. European Society of Cardiology. Prevention of cardiovascular disease in overweight adults: 2024 guidelines update. Eur Heart J. 2024;45(29):2782–2833.
26. Reddy YNV, Carter RE, Obokata M, et al. Obesity and overweight as early determinants of heart failure phenotypes. JACC Heart Fail. 2025;13(4):357–368.
27. Cheng S, Rosen BD, Drazner MH, et al. Longitudinal determinants of LV mass progression in overweight adults. Circulation. 2024;149(7):513–523.
28. Kim SH, Cho IJ, Kim KH, et al. Cardiac geometry and mass in metabolically healthy overweight adults. Diabetes Metab J. 2024;48(6):783–795.
29. García-Blas S, Rueda F, Verdú JM, et al. Overweight and myocardial mechanics: implications for early intervention. Rev Esp Cardiol. 2025;78(2):109–118.
30. de Simone G, Izzo R, Mancusi C. Overweight, cardiac remodeling, and prevention: redefining thresholds. Curr Opin Cardiol. 2025;40(5):423–430.
31. Fudim M, Pandey A, Chatterjee NA. Cardiometabolic prevention starting in the overweight range. J Am Heart Assoc. 2025;14(6):e031234.
