Cardiovascular Prevention and Pharmacotherapy

Review Articles

Clinical and preclinical obesity: cardiovascular implications of a new diagnostic paradigm: Ga Eun Nam; Cardiovasc Prev Pharmacother. 2025;7(2):21-27. Published online April 25, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e6

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The traditional definition of obesity, relying solely on body mass index, inadequately captures individual health status and is insufficient for guiding therapeutic interventions. In January 2025, The Lancet Diabetes & Endocrinology Commission proposed a paradigm-shifting redefinition that introduces the concepts of “clinical obesity” and “preclinical obesity.” Clinical obesity is defined as a chronic, systemic illness characterized by excess adiposity resulting in functional impairments in tissues, organs, or overall individual health. In contrast, preclinical obesity involves excess adiposity without current functional impairment. This review examines the significance of this new diagnostic paradigm for cardiovascular disease prevention and risk assessment. From a cardiovascular perspective, the new framework offers several advantages: it facilitates personalized intervention strategies based on individual risk profiles, refines cardiovascular risk assessments by incorporating body fat distribution and functional parameters, promotes more efficient resource allocation, and shifts treatment goals toward functional improvements beyond mere weight loss. Although further research is required to evaluate practical implementation and long-term outcomes, this novel approach represents a substantial advancement in obesity management and cardiovascular disease prevention.

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Muscle Insulin Resistance Elicits Muscle Atrophy in Obesity
Omid Razi, Nastaran Zamani, Ayoub Saeidi, Marios Hadjicharalambous, Khadija Ayed, Anthony C. Hackney, Juan Del Coso, Ismail Laher, Giovanna Muscogiuri, Hassane Zouhal
Current Obesity Reports.2025;[Epub] CrossRef

Use of dual-energy x-ray absorptiometry for body composition in chronic disease management: Tae Nyun Kim; Cardiovasc Prev Pharmacother. 2024;6(4):128-134. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e13

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Abstract PDF

As individuals age or contend with chronic diseases, shifts in body composition often emerge, characterized by a loss of muscle mass and an increase in fat mass, even among those with stable body weight. Both obesity and sarcopenia are key drivers of frailty, disability, and heightened morbidity and mortality. The simultaneous decline in skeletal muscle and accumulation of visceral fat can work synergistically, magnifying their detrimental effects on physical function and metabolic health. Today, dual-energy x-ray absorptiometry (DEXA) is widely recognized as one of the most versatile imaging techniques for assessing not only osteoporosis but also sarcopenia and obesity. Whole-body DEXA facilitates comprehensive analysis, offering detailed insights into fat mass, non-bone lean mass, and bone mineral content at both total and regional levels. DEXA is highly valued for its accuracy, reproducibility, speed, affordability, and low radiation exposure. Furthermore, advancements in DEXA technology and software now allow for precise estimation of visceral adipose tissue. This review underscores the clinical applications of whole-body DEXA, focusing on the use of muscle and fat mass indices in diagnosing low muscle mass, sarcopenia, and sarcopenic obesity, aligned with the latest research and guidelines.

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Developing a reliable and convenient methodology for ultrasound muscle assessment in critically ill patients: A reliability study
Yong Jae Na, Shin Who Park, Woo Jung Seo, Kyung Cheon Seo, Jong Yoon Chang, Hyo Jin Lim, Hyeon Jeong Moon, Roo Ma Lee, Eun Jae Ko, Sang-Bum Hong, Won Kim
Medicine.2025; 104(17): e42263. CrossRef
The Critical Role of Body Composition Assessment in Advancing Research and Clinical Health Risk Assessment across the Lifespan
Jonathan P. Bennett, Soo Lim
Journal of Obesity & Metabolic Syndrome.2025; 34(2): 120. CrossRef
Effects of vegan diets and lifestyle on adult body composition: a narrative review
Boštjan Jakše, Nataša Fidler Mis, Zlatko Fras, Derrick R. Tanous, Katharina Wirnitzer
Food & Function.2025; 16(15): 5994. CrossRef
Real-Time Microwave Medical Scanning [Application Notes]
Paul Meaney, Roberta diFlorio-Alexander, Zamzam Kordiboroujeni, Timothy Raynolds, Robin Augustine
IEEE Microwave Magazine.2025; 26(10): 66. CrossRef
Influence of 8‐week endurance training on resting energy expenditure and body composition in women
Ida E. Löfberg, Aino Kuljukka, Vera M. Salmi, Johanna K. Ihalainen, Heikki Kyröläinen, Anthony C. Hackney, Ritva S. Mikkonen
Physiological Reports.2025;[Epub] CrossRef
Bone Health in Handball Players: The Role of Exercise
Zacharoula Papadopoulou, Eleni Maria Vrampa, Angelo V Vasiliadis, Nikiforos Galanis
Cureus.2025;[Epub] CrossRef

Original Article

Obesity and 30-day case fatality after hyperglycemic crisis hospitalizations in Korea: a national cohort study: Hojun Yoon, Hyun Ho Choi, Giwoong Choi, Sun Ok Song, Kyoung Hwa Ha, Dae Jung Kim; Cardiovasc Prev Pharmacother. 2023;5(3):74-80. Published online July 27, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e10

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Abstract PDF Supplementary Material: Background
We determined the case fatality rate associated with hospitalization due to hyperglycemic crises and investigated the relationship between obesity status and case fatality for hyperglycemic crises.
Methods
From the Korean National Health Insurance Service-National Sample Cohort, 729 adults who visited the emergency room or were hospitalized due to hyperglycemic crises between January 1, 2010, and December 31, 2019, were included. Preobesity or obesity was defined as a body mass index ≥23.0 kg/m2. Case fatality rates are presented as the proportion of adults who died within 30 days of hospitalization. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for 30-day fatalities according to preobesity or obesity status.
Results
The 30-day case fatality rate for hyperglycemic crises was 11.2%. In those aged ≥65 years, the fatality rate was twice as high as that in those aged 20 to 64 years (13.8% vs. 6.8%). Adults with preobesity or obesity had a lower fatality rate than those with normal weight (9.5% vs. 14.0%). After adjustment for confounding variables, preobesity or obesity was found to be significantly associated with a decreased risk for 30-day case fatality compared to normal weight (HR, 0.63; 95% CI, 0.40–0.98).
Conclusions
In Korea, hyperglycemic crises had a high fatality rate. Management needs to be improved to prevent hyperglycemic crises and reduce mortality.

Review Articles

Research on obesity using the National Health Information Database: recent trends: Eun-Jung Rhee; Cardiovasc Prev Pharmacother. 2023;5(2):35-40. Published online April 28, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e8

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Abstract PDF

The prevalence of obesity has increased markedly in Korea during the past few decades. Korea is one of the most well-organized countries in terms of its National Health Insurance System (NHIS), which conducts screening examinations. Since the NHIS is unified and managed by the government, its data—contained in the National Health Insurance Database (NHID)—are centralized. The Korean government has recently encouraged researchers to access the NHID, conduct research, and write papers to convey their findings. Expanded research using the NHID could shed light on the future of big data research. In this review, I would like to present an overview of current trends in obesity research using the NHID.

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Income-Related Disparities in Mortality Among Young Adults With Type 2 Diabetes
Ji Yoon Kim, Sojeong Park, Minae Park, Nam Hoon Kim, Sin Gon Kim
JAMA Network Open.2024; 7(11): e2443918. CrossRef

Metabolically healthy obesity: it is time to consider its dynamic changes: Yun Kyung Cho, Chang Hee Jung; Cardiovasc Prev Pharmacother. 2022;4(4):123-131. Published online October 24, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e19

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Abstract PDF

Obesity reduces life expectancy, lowers quality of life, and causes numerous cardiometabolic diseases and some cancers. However, the individual risk of developing obesity-associated comorbidities is highly variable and cannot be explained only by body mass index. Observations that some obese people have a low risk for cardiometabolic disorders gave rise to the notion of metabolically healthy obesity (MHO). Despite the lack of a precise definition, MHO is typically identified by normal glucose and lipid metabolism indices, as well as the absence of hypertension. In individuals with MHO, the absence of metabolic abnormalities may minimize the risk of mortality, cardiovascular diseases, chronic kidney disease, dementia, and cancer, compared to metabolically unhealthy individuals with obesity. However, MHO appears to be a temporary phenotype that may not confer permanent benefits to individuals with obesity, further justifying therapeutic efforts to maintain metabolic fitness. In this review, we describe the traits of the MHO phenotype, its changeable nature, and the factors associated with phenotype change. In addition, we discuss the clinical outcomes of the MHO phenotype, particularly focusing on the transition of metabolic health over time and its effect on cardiometabolic disorders. Finally, the clinical importance of maintaining metabolic health is emphasized.

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Predictors of cardiovascular outcomes in individuals with different obesity phenotypes
I.L. Berezenko, E.V. Filippov, M.V. Volchenkova
Russian Journal of Preventive Medicine.2025; 28(11): 59. CrossRef

The effects and side effects of liraglutide as a treatment for obesity: Jeonghoon Ha, Jin Yu, Joonyub Lee, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2022;4(4):142-148. Published online October 20, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e18

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Abstract PDF

The incidence of obesity is increasing throughout the world, including Korea. Liraglutide, the main purpose of which is glucose control, has recently gained significant attention due to its additional effect on weight loss. Liraglutide injections have been widely used as an important treatment for obese patients in Korea. In addition to weight loss, liraglutide has various other effects, such as prevention of cardiovascular disease. Despite its excellent effect on weight loss, notable side effects, such as nausea and vomiting, have also been associated with liraglutide. Despite these side effects, liraglutide has not been discontinued due to its beneficial effects on weight loss. Nonetheless, there are reports wherein patients did not experience weight loss upon taking the drug. As such, there is a possibility of liraglutide misuse and abuse. Therefore, physicians need to have a broad understanding of liraglutide and understand the advantages and disadvantages of liraglutide prescription.

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From evolutionary advantage to global epidemic: the multisystemic impact of obesity on metabolic health and the potential of bergamot (Citrus bergamia)
Luís Eduardo Sormani, Thiago Luiz Novaga Palacio, Camila Renata Corrêa
Nutrire.2025;[Epub] CrossRef
Natural product-based treatment potential for type 2 diabetes mellitus and cardiovascular disease
Dharmsheel Shrivastav, Satyam Kumar Kumbhakar, Shivangi Srivastava, Desh Deepak Singh
World Journal of Diabetes.2024; 15(7): 1603. CrossRef

Original Article

Development of a predictive model for the side effects of liraglutide: Jiyoung Min, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2022;4(2):87-93. Published online April 27, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e12

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Abstract PDF Supplementary Material

Background
Liraglutide, a drug used for the management of obesity, has many known side effects. In this study, we developed a predictive model for the occurrence of liraglutide-related side effects using data from electronic medical records (EMRs).
Methods
This study included 237 patients from Seoul St. Mary's Hospital and Eunpyeong St. Mary's Hospital who were prescribed liraglutide. An endocrinologist obtained medical data through an EMR chart review. Model performance was evaluated using the mean of the area under the receiver operating characteristic curve (AUROC) with a 95% confidence interval (CI).
Results
A predictive model was developed for patients who were prescribed liraglutide. However, 37.1% to 75.5% of many variables were missing, and the AUROC of the developed predictive model was 0.630 (95% CI, 0.551–0.708). Patients who had previously taken antiobesity medication had significantly fewer side effects than those without previous antiobesity medication use (20.7% vs. 41.4%, P<0.003). The risk of side effect occurrence was significantly higher in patients with diabetes than in patients without diabetes by 2.389 times (odds ratio, 2.389; 95% CI, 1.115–5.174).
Conclusions
This study did not successfully develop a predictive model for liraglutide-related side effects, primarily due to issues related to missing data. When prescribing antiobesity drugs, detailed records and basic blood tests are expected to be essential. Further large-scale studies on liraglutide-related side effects are needed after obtaining high-quality data.

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The effects and side effects of liraglutide as a treatment for obesity
Jeonghoon Ha, Jin Yu, Joonyub Lee, Hun-Sung Kim
Cardiovascular Prevention and Pharmacotherapy.2022; 4(4): 142. CrossRef

Review Articles

Obesity and heart failure with preserved ejection fraction: pathophysiology and clinical significance: Da Young Lee; Cardiovasc Prev Pharmacother. 2022;4(2):70-74. Published online April 27, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e10

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Abstract PDF

Obesity is a risk factor for heart failure and cardiovascular disease. Of particular note, over 80% of patients with heart failure with a preserved ejection fraction (HFpEF) are overweight or obese. In this study, we aimed to review the association between obesity and HFpEF. Obese patients with HFpEF exhibit a distinct phenotype. In addition to impaired left ventricular (LV) diastolic function and high filling pressures, obese patients with HFpEF possess other factors that cause elevated LV filling pressure, such as a greater dependence on plasma volume expansion, aggravated pericardial restraint, and increased ventricular interaction. Obesity can contribute to HFpEF through hemodynamic, neurohormonal, inflammatory, and mechanical mechanisms. An increased amount of body fat can induce plasma volume expansion, resulting in chamber remodeling, pericardial restraint, and ultimately elevations in LV filling pressure. Obesity can mediate the activation of sympathetic nervous system signaling and the renin-angiotensin-aldosterone system. These unique pathophysiological characteristics of individuals with both obesity and HFpEF suggest that obesity with HFpEF can be considered a specific phenotype. Future research is expected to clarify effective treatment modalities for obesity-related HFpEF.

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Evolving Role of Double and Triple Therapy With GLP-1 Receptor Agonists in Obesity and Cardiovascular Disease
Phelopater Sedrak, Raj Verma, Meena Verma, Kim A. Connelly
Canadian Journal of Cardiology.2025; 41(9): 1809. CrossRef
Therapeutic Potential of GLP-1 Receptor Agonists in Heart Failure with Preserved Ejection Fraction (HFpEF) in Obese Patients
Ravi Patel, Emmanuel Kokori, Gbolahan Olatunji, Faith Adedayo Adejumo, Joan Dumebi Ukah, Adetola Emmanuel Babalola, Andrew Ndakotsu, Israel Charles Abraham, Nicholas Aderinto
Current Heart Failure Reports.2025;[Epub] CrossRef

Body Weight Change and Cardiovascular Disease: Effect of Weight Gain, Weight Loss, and Weight Cycling: Jung-Hwan Cho, Eun-Jung Rhee, Won-Young Lee; Cardiovasc Prev Pharmacother. 2021;3(4):73-81. Published online October 31, 2021; DOI: https://doi.org/10.36011/cpp.2021.3.e12

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Abstract PDF

Obesity is an independent risk factor for the development and progression of cardiovascular disease (CVD). Various cardiovascular outcomes are related to the association between body weight change and CVD. Metabolically healthy obese individuals could have a better prognosis in terms of cardiovascular morbidity and mortality than metabolically unhealthy obese individuals. Smoking cessation causes significant weight gain and consequent deterioration of the metabolic profile despite not impairing the cardiovascular benefits. Intentional weight loss has a consistent cardiovascular protective effect, but unintentional weight loss due to progressive catabolism and loss of muscle mass could be associated with poor cardiovascular outcomes. Obese individuals who are successful in losing weight with subsequent regain (weight cycling) could have an unfavorable cardiometabolic profile and the risk of CVD. Further studies are needed to evaluate the impact of weight changes on CVD by identifying unknown pathophysiology and to decide appropriate management and interventions for various phenotypes of weight change.

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Investigating the efficacy and feasibility of using a whole-of-diet approach to lower circulating levels of C-reactive protein in postmenopausal women: a mixed methods pilot study
Stephanie Cowan, Aimee Dordevic, Andrew J. Sinclair, Helen Truby, Surbhi Sood, Simone Gibson
Menopause.2023; 30(7): 738. CrossRef

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