Obesity is a major global health issue and a leading cause of premature death. The prevalence of obesity has been rising faster than most other known modifiable risk factors. In a Global Burden of Disease analysis, the prevalence of obesity was found to have doubled in more than 70 countries from 1980 to 2013.1 Obesity can adversely affect several health conditions but about two-thirds of deaths attributable to excess body mass index (BMI) are cardiovascular.1 This makes cardiovascular risk management a priority goal in people with obesity.

Several biological mechanisms are implicated in the pathway between adiposity and the risk of cardiovascular diseases. Of these, elevated blood pressure (BP) stands out as the most important mediator of obesity-related risk. In a pooled analysis of cohort studies, about two-thirds of the excess risk for stroke and one-third of the risk for ischaemic heart disease that was related to high BMI were mediated through elevated blood pressure.2 This is because adiposity is by far the most important precursor of elevated BP. In an analysis of the Framingham Offspring Study, excess body fat was attributed to approximately 70% of cases of early-onset hypertension in men and 64% in women.3 In this context, it seems unsurprising that a large fraction of patients with hypertension are also obese. With the rising rates of obesity and elevated BP, effective and safe interventions targeting adiposity will continue to grow in importance.

A substudy of SURMOUNT-1 trial, recently published Heart, investigates the effects of tirzepatide, a dual glucose-dependent insulinotropic …