Editorial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2025; 17(8): 108749
Published online Aug 26, 2025. doi: 10.4330/wjc.v17.i8.108749
Is metabolically healthy obesity shaped by inflammation, gender differences, and fat distribution?
Davide Ramoni, Luca Liberale, Federico Carbone, Fabrizio Montecucco
Davide Ramoni, Luca Liberale, Federico Carbone, Fabrizio Montecucco, Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
Luca Liberale, Federico Carbone, Fabrizio Montecucco, First Clinic of Internal Medicine, Department of Internal Medicine, Italian Cardiovascular Network, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
Author contributions: Montecucco F designed the drafting of the manuscript and supervised the work; Ramoni D performed the conceptualization and wrote the full manuscript; Liberale L and Carbone F reviewed and edited the final version; all authors have read and approve the final manuscript.
Conflict-of-interest statement: There is no conflict of interest or financial activities for any aspect of the submitted work. Outside the submitted work, declaration of competing interest Liberale L is coinventor on the International Patent (wo/2020/226993) filed in April 2020 and relating to the use of antibodies which specifically bind IL-1a to reduce various sequelae of ischemia-reperfusion injury to the central nervous system. Liberale L has received speaker fees outside of this work from Daichi-Sankyo. The other authors have no conflict to disclose.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrizio Montecucco, MD, PhD, Professor, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, Genoa 16132, Italy. fabrizio.montecucco@unige.it
Received: April 22, 2025
Revised: May 25, 2025
Accepted: July 18, 2025
Published online: August 26, 2025
Processing time: 120 Days and 17.9 Hours
Core Tip

Core Tip: Obesity is not a uniform condition but comprises multiple phenotypes with distinct cardiovascular (CV) risks. The concept of metabolically healthy obesity is increasingly challenged by evidence of low-grade inflammation, ectopic fat accumulation, and adipose dysfunction. Inflammation, particularly in visceral and epicardial fat, plays a central role in driving subclinical CV damage, even in the absence of overt metabolic disease. Postmenopausal women are especially vulnerable due to hormonal shifts and fat redistribution. Integrating fat phenotype, inflammatory biomarkers, and sex-specific factors is essential for precise cardiometabolic risk management and targeted prevention, moving beyond body mass index-based assessments.