Body composition and cardiovascular disease: Clinical implications beyond body mass index
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Mucahit Yetim 1 , Macit Kalçık 1 * , Abdülmelik Birgün 2 , Abdullah Sarıhan 1 , Muhammet Cihat Çelik 2 , Mehmet Mustafa Yılmaz 2 , Lütfü Bekar 1 , Yusuf Karavelioğlu 1
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1 Hitit University, Faculty of Medicine, Department of Cardiology, Çorum, TÜRKİYE2 Hitit University, Erol Olçok Education and Research Hospital, Department of Cardiology, Çorum, TÜRKİYE* Corresponding Author

Abstract

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, and excess adiposity is a major contributor to cardiovascular (CV) risk. However, obesity is a heterogeneous condition, and body mass index (BMI) alone fails to capture important differences in fat distribution and lean mass that substantially influence CV outcomes. Growing clinical and epidemiological evidence indicates that body composition, rather than body weight per se, provides a more accurate and biologically meaningful framework for CV risk assessment. This narrative review summarizes clinical evidence linking key components of body composition, including total and regional adiposity, skeletal muscle mass, and ectopic fat depots, to CV risk and prognosis. Central and visceral adiposity are consistently shown to be more strongly associated with cardiometabolic dysfunction, atherosclerosis, and CV events than generalized obesity. In parallel, reduced lean mass and sarcopenia emerge as independent predictors of adverse CV outcomes, particularly in older adults and patients with established CVD. Ectopic fat depots, such as epicardial and hepatic fat, further contribute to CV pathology through local and systemic mechanisms. Collectively, these findings highlight the limitations of BMI-centered approaches and support the integration of body composition measures into CV risk stratification. Emphasizing body recomposition, with reduction of harmful fat depots and preservation of skeletal muscle, may enable more precise, individualized strategies for CV prevention and management.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Review

J CLIN EXP INVEST, Volume 17, Issue 2, June 2026, Article No: em00856

https://doi.org/10.29333/jcei/18135

Publication date: 01 Apr 2026

Online publication date: 15 Mar 2026

Article Views: 21

Article Downloads: 8

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