Impact of obesity on cardiac structure and function in adults without major comorbidities: insights from CV-Prevital

Introduction Obesity is an important modifiable determinant of cardiovascular (CV) risk and subclinical myocardial remodeling. The recent redefinition of obesity, which takes into account measures of central adiposity such as waist-to-height ratio, can stratify individuals with cardiometabolic risk early on. Therefore, this study aimed to assess the impact of abdominal obesity on cardiac structure and function in a population without overt cardiometabolic disease. Methods From a cohort of 1,068 asymptomatic individuals without diabetes or chronic kidney disease (CKD), we selected 512no-smoker participants without a diagnosis of hypertension or dyslipidaemia at baseline from the CV-PREVITAL (Primary Cardiovascular Prevention in the Italian Population) study. Obesity was defined as BMI ≥ 30 kg/m² and either a waist-to-height ratio ≥ 0.5 or a waist circumference exceeding WHO sex-specific cut-offs.Anthropometric, clinical, and echocardiographic parameters were compared between partecipants without obesity (n=443, 87%) and with obesity (n= 69, 13%) using non-parametric and chi-square tests. Results Participants affected by obesity exhibited higher but within upper limit systolic and diastolic blood pressure (Table). Left ventricle (LV) wall thickness was slightly higher in obesity (septum: p = 0.053; posterior wall: p = 0.043), with increased LV mass index (72.0 [56.0–82.3] vs 66.0 [56.0–77.0] g/m², p = 0.039). The prevalence of concentric remodeling was comparable (19%, p = 0.904). LV ejection fraction was slightly lower in obese individuals (61.0 [57.0–66.0] vs 63.0 [59.0–66.0], p = 0.012), whereas global longitudinal strain remained preserved (p = 0.921). Left atrial volume index (18.0 [15.0–23.0] vs 16.0 [13.0–19.0], p = 0.002) and epicardial adipose tissue thickness (3.8 [3.0–5.0] vs 3.0 [2.0–4.3] mm, p = 0.004) were significantly higher in participants with abdominal obesity. Conclusion In healthy adults without history of hypertension, dyslipidaemia, diabetes, or CKD, obesity—defined by integrated adiposity anthropometric criteria—was associated with early structural cardiac changes, including higher LV mass, larger atrial volumes, and increased epicardial adipose tissue thickness. These findings support the concept that abdominal obesity independently contributes to subclinical cardiac remodeling.