Study: Obesity Increases Risk of Cardiovascular Complications in COVID-19


Obesity, high blood pressure, and diabetes were the most common comorbidities.

Obesity was found to be the most common factor associated with the development of endothelial dysfunction in COVID-19 patients, which can increase the risk of events such as heart attacks and stroke, according to a study published in the journal Obesity.

The study authors examined 109 patients hospitalized due to acute COVID-19 in non-critical condition.

“We characterized the patients in general and then set out to identify the factors that might modulate or intensify endothelial damage,” said study author Alessandro Domingues Heubel, a PhD candidate in physical therapy at the Federal University of São Carlos (UFSCar) in the state of São Paulo, Brazil, in a press release. “The results showed that the key factor was BMI [body mass index], followed quite a way behind by blood creatinine level, a marker of kidney function.”

Huebel added that body mass index (BMI) is among the main parameters used by health professionals to measure overweight and obese patients, with individuals who have a BMI of 30 kg/m2 being considered obese. Participants in the study were undergoing treatment at Bauru State Hospital and Santa Casa de São Carlos in São Paulo state. Obesity, high blood pressure, and diabetes were the most common comorbidities.

After hospital admission, blood samples were collected and endothelial function was assessed non-invasively 72 hours later by the flow-mediated dilation method, where the diameter of the brachial artery is measured by high-resolution ultrasound before and after circulation is restricted in the forearm for a few minutes, according to a press release.

“Immediately after removal of the occlusion cuff, the flow of blood in the artery increases, and this is a mechanical stimulus for the endothelial cells [which line the inside of blood vessels] to produce nitric oxide, a vasodilator,” Heubel said in a press release. “The more the artery dilates, the better the endothelial function. We found [flow-mediated dilation] to be very low in these obese COVID-19 patients during the period of active infection.”

The researchers also assessed muscle health by measuring grip strength with a dynamometer and analyzed blood levels of hemoglobin, leukocytes, lymphocytes, creatinine, and platelets, in addition to C-reactive protein, ferritin, and D-dimer. Time since symptom onset, smoking, comorbidities, and medication use were also looked at. The researchers noted that 72% of patients were using supplemental oxygen.

Using only univariate regression—a statistical technique that predicts values of 1 variable from the values of another—and multiple regression, the researchers sought to find the determinants of endothelial dysfunction in the study sample.

“In clinical practice, we find that obese patients have more cardiovascular events while they’re hospitalized,” said Heubel’s thesis advisor Renata Gonçalves Mendes, in a press release. “Our study can help understand the mechanisms underlying this problem and why obesity increases the risk of progressing to severe COVID-19.”

According to the researchers, health workers should be more attentive to vascular complications when treating obese COVID-19 patients.

“They’re more susceptible to cardiovascular events and hence need more assistance. Several strategies are available to prevent complications developing,” Heubel said in a press release.

These findings also paved the way for novel therapeutic approaches to focus on endothelium, according to Mendes.

“It would be a good idea to look for a compound capable of blocking the process that leads to endothelial dysfunction, given the associated risk of serious complications,” Mendes said in a press release.


Study helps understand why obesity increases risk of cardiovascular complications in COVID-19. EurekAlert! Published November 12, 2021. Accessed November 15, 2021.

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