The management of cardiovascular diseases (CVD) in patients with obesity presents numerous challenges. Obesity has a negative effect on almost all of the major CVD risk factors, and adversely influences cardiovascular structure and function. Patients who are overweight or obese have a higher incidence of almost all CVDs compared with patients who are of normal weight. However, those who are overweight or obese seem to have a better short-term and medium-term prognosis after major CVD events and interventional procedures or cardiac surgeries than leaner patients, a phenomenon termed the 'obesity paradox'. In considering the mechanisms underlying this paradox, we review evidence of the deleterious consequences of obesity in patients with coronary heart disease, and the limited data on the benefits of weight loss in patients with CVD. Additional studies are needed on the efficacy of purposeful weight loss on cardiovascular outcomes to determine the ideal body composition for patients with CVD.

肥胖患者的心血管疾病（CVD）的管理面临许多挑战。肥胖对几乎所有主要的CVD危险因素均具有负面影响，并对心血管结构和功能产生不利影响。与体重正常的患者相比，超重或肥胖的患者几乎所有CVD的发生率均较高。但是，那些超重或肥胖的人在发生重大CVD事件，介入手术或心脏手术后似乎比较瘦的患者有更好的短期和中期预后，这种现象被称为“肥胖悖论”。在考虑这种悖论的潜在机制时，我们回顾了肥胖对冠心病患者的有害影响的证据，以及有关CVD患者减肥益处的有限数据。