**Abstract**

Cardiovascular disease in populations with obesity is a major concern because of it is epidemic proportion. Obesity leads to the development of cardiomyopathy directly via inflammatory mediators and indirectly by obesity-induced hypertension, diabetes, and coronary artery diseases. Metabolic disturbances such as increased free fatty acid levels, insulin resistance, elevated levels of adipokines, myocardial remodeling, activation of the sympathetic nervous and renin-angiotensinaldosterone systems, and small-vessel disease are the most important mechanisms in the development of obesity cardiomyopathy. The myocardial changes related with obesity are increasingly recognized, and they are independent of classic risk factors as hypertension, coronary artery disease, and obstructive sleep apnea. There is a wide range of evidence: the association between heart failure and obesity shown in epidemiologic studies; the confirmation of the association of adiposity with left ventricular dysfunction, independent of hypertension, coronary artery disease, and other heart diseases; and experimental evidence of functional and structural changes in the myocardium in response to increased adiposity support the existence of a cardiomyopathy related to obesity.

**Keywords:** heart failure, obesity, adipokines, myocardiopathy
