Obesity and cardiac metabolism in women.

Obesity is a vexing problem for the clinician and for the cardiovascular physiologist alike. Although we tend to blame an “obesogenic” environment, nobody really knows the cause for the current obesity epidemic. Is it the environment? Is it genes? Or is it the environment acting on certain genes? Currently approximately 6% of the American population is clinically severely obese (1) and it is well documented that obesity reduces life expectancy (2). Death and disability from heart disease feature prominently in obesity. Most importantly, the dysregulated lipid metabolism in obesity does not stop in the arterial wall. Obesity is, for example, an independent risk factor for heart failure, as defined by criteria of the Framingham study (3). The data also show that women are more likely to develop heart failure than men (14% vs. 11%). It is tempting to speculate that the gender difference can be traced to the metabolism of energy-providing substrates.