Mechanisms of formation and progression of cardiovascular pathology in obesity

Obesity is currently recognized as a pandemic of modernity and a serious medical and social problem that brings significant economic damage to society. This is largely due to the increase and younger onset of obesity-related morbidity, accompanied by cardiovascular pathology, which worsens quality of life, leading to early temporary and permanent loss of working capacity and premature death. This review presents an analysis of current understanding of the risks and mechanisms of cardiovascular system damage in obesity, the role of insulin resistance, the hormonal activity of adipose tissue, and the prognostic significance of different types of obesity. Along with traditional cardiovascular risk factors, obesity is associated with a range of metabolic and hormonal disorders, the development of systemic inflammation, and oxidative stress, leading to specific myocardial damage—lipotoxic cardiomyopathy. This pathological condition significantly contributes to the development of myocardial dysfunction (heart failure, urgent arrhythmias with the risk of sudden cardiac death) even in the absence of ischemic heart disease. The review provides current data on the features of myocardial remodeling in obesity, the mechanisms of its development and progression, and methods of diagnosis. It emphasizes that the problem of diagnosing myocardial dysfunction, as well as adequate treatment of this pathology—including non-drug interventions, surgical procedures, and the use of weightloss medications—is far from being resolved. This necessitates in-depth research into this pathology and the search for new, optimal, effective, and safe methods for prevention and treatment.