Sudden Death in Obesity: Mechanisms and Management (JACC December 2024-1)-Article: Sudden Death in Obesity: Mechanisms and Management

Article: Sudden Death in Obesity: Mechanisms and Management

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The article, "Sudden Death in Obesity: Mechanisms and Management," addresses the rising public health issue of sudden cardiac death (SCD) linked to obesity, a condition increasingly prevalent worldwide. Obesity is recognized to alter metabolism and raise cardiovascular risks, significantly contributing to SCD—a critical and sudden loss often due to cardiac issues. The authors emphasize improved risk stratification and preventive measures for obesity-related SCD.<br /><br />Obesity is characterized by an excessive accumulation of body fat, with distinctions made for severity levels based on body mass index (BMI). Importantly, visceral fat—fat surrounding internal organs—is more strongly correlated with SCD risk than general obesity or BMI. This form of obesity profoundly affects mortality and morbidity due to its active metabolic nature. <br /><br />Studies have shown that obesity increases the likelihood of SCD across various demographics, with a higher BMI correlating with an increased risk of SCD. Conversely, the "obesity paradox"—wherein mildly obese individuals might experience protective health benefits—adds complexity to understanding these dynamics. Moreover, nighttime SCD incidences are more frequent among obese individuals, potentially linked to obstructive sleep apnea common in this group.<br /><br />Obesity-related SCD involves intrinsic cardiac alterations, such as cardiac hypertrophy and potential arrhythmias stemming from altered electrical signaling within the heart. The "fatty heart" concept theorizes that lipid accumulation in cardiac tissue due to obesity can disrupt electrical pathways and contribute to arrhythmias and SCD.<br /><br />Preventive measures are considered crucial. Recent medical advancements, such as glucagon-like peptide-1 (GLP-1) agonists and bariatric surgery, demonstrate potential in reducing obesity and related cardiovascular risks. However, further research is necessary to verify their effectiveness in reducing SCD risk. Enhanced SCD risk stratification could involve a combination of biomarkers, including metabolic alterations and cardiac imaging, tailored to assess and mitigate risks specific to obese individuals.

Keywords

sudden cardiac death

obesity

cardiovascular risks

visceral fat

obesity paradox

sleep apnea

cardiac hypertrophy

arrhythmias

GLP-1 agonists

bariatric surgery