The metabolic syndrome is associated with cardiovascular deterioration and encompasses a constellation of risk factors, which include excess abdominal visceral fat (AVF), atherogenic dyslipidemia etc. At ideal BMI, adipokines have purely beneficial effects on metabolism, cardiac function, and vascular endothelial well-being. Obesity is characterized by a hyperdynamic circulation. Increases in stroke volume (SV) and cardiac output (CO) are usually described as being linear and directly proportional to increased BMI. Histologically, the most common post-mortem finding in obesity is myocyte hypertrophy. Obesity cardiomyopathy or congestive heart failure (CHF) associated with obesity, can be caused by primary systolic heart failure (SHF), usually associated with eccentric hypertrophy and systolic dysfunction. Atrial fibrillation is commonly associated with morbid obesity (MO). Surgically induced weight loss reverses many of the maladaptive functional and structural cardiovascular changes associated with MO and reduces overall risk.