4.5 Review

Heart Failure and Obesity: The Latest Pandemic

期刊

PROGRESS IN CARDIOVASCULAR DISEASES
卷 78, 期 -, 页码 43-48

出版社

W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.pcad.2023.05.003

关键词

Obesity; Weight loss; Heart failure; Cardiac dysfunction; Lipotoxicity; Social determinants of health

向作者/读者索取更多资源

The increase in obesity rates, particularly among socio-economically disadvantaged individuals, has contributed significantly to the prevalence of heart failure. Obesity indirectly affects heart failure through the development of metabolic risk factors and directly affects the myocardium. Multiple mechanisms, including hemodynamic changes and adipose tissue effects, contribute to myocardial dysfunction and increased risk of heart failure. Despite the obesity paradox, intentional weight loss has been shown to improve metabolic risk factors, myocardial dysfunction, and quality of life in patients with heart failure. Ongoing clinical trials are investigating the impact of weight loss on cardiovascular outcomes.
The marked rise in rates of obesity, which is most prominent among individuals from socio-economically disadvantaged circumstances, has been a powerful contributor to the rising prevalence of heart failure (HF). Obesity has indirect effects on HF through the development of several metabolic risk factors, but also direct adverse effects on the myocardium. Obesity contributes to myocardial dysfunction and HF risk through multiple mechanisms, including hemodynamic changes, neurohormonal activation, endocrine and paracrine effects of adipose tissue, ectopic fat deposition and lipotoxicity. These processes principally result in concentric left ventricular (LV) remodeling and predominant increase in the risk for HF with preserved LV ejection fraction (HFpEF). Despite the excess risk for HF associated with obesity, there is a well described obesity paradox in which individuals with overweight and grade I obesity have better survival than those with normal weight and underweight. Despite the obesity paradox among individuals with prevalent HF, intentional weight loss is associated with improvements in metabolic risk factors, myocardial dysfunction and quality of life, in a dose-response fashion. In matched observational studies of bariatric surgery patients, marked weight loss is associated with decreased risk for developing HF, as well as improved cardiovascular disease (CVD) outcomes in those with existing HF. Ongoing clinical trials using powerful new obesity pharmacotherapies in individuals with obesity and CVD may provide definitive information regarding the cardiovascular impact of weight loss. Given the powerful contribution of rising obesity prevalence to rates of HF, addressing these intertwined epidemics is a clinical and public health priority. & COPY; 2023 Elsevier Inc. All rights reserved.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.5
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据