Update on obesity, the obesity paradox, and obesity management in heart failure

IF 5.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Progress in cardiovascular diseases Pub Date : 2024-01-01 DOI:10.1016/j.pcad.2024.01.003
Pamela L. Alebna , Anurag Mehta , Amin Yehya , Adrian daSilva-deAbreu , Carl J. Lavie , Salvatore Carbone
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Abstract

Obesity is a major public health challenge worldwide. It is costly, predisposes to many cardiovascular (CV) diseases (CVD), is increasing at an alarming rate, and disproportionately affects people of low-socioeconomic status. It has a myriad of deleterious effects on the body, particularly on the CV system. Obesity is a major risk factor for heart failure (HF) and highly prevalent in this population, particularly in those with HF with preserved ejection fraction (HFpEF), to the extent that an obesity HFpEF phenotype has been proposed in the literature. However, once HF is developed, an obesity paradox exists where those with obesity have better short- and mid-term survival than normal or underweight individuals, despite a greater risk for hospitalizations. It may be argued that excess energy reserve, younger patient population, higher tolerability of HF therapy and better nutritional status may account for at least part of the obesity paradox on survival. Furthermore, body mass index (BMI) may not be an accurate measure of body composition, especially in HF, where there is an excess volume status. BMI also fails to delineate fat-free mass and its components, which is a better predictor of functional capacity and cardiorespiratory fitness (CRF), which particularly is increasingly being recognized as a risk modifier in both healthy individuals and in persons with comorbidities, particularly in HF. Notably, when CRF is accounted for, the obesity paradox disappears, suggesting that improving CRF might represent a therapeutic target with greater importance than changes in body weight in the setting of HF.

In this narrative review, we discuss the current trends in obesity, the causal link between obesity and HF, an update on the obesity paradox, and a description of the major flaws of BMI in this population. We also present an overview of the latest in HF therapy, weight loss, CRF, and the application of these therapeutic approaches in patients with HF and concomitant obesity.

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肥胖、肥胖悖论和心力衰竭肥胖管理的最新进展。
肥胖症是全球面临的一项重大公共卫生挑战。肥胖症代价高昂,易诱发多种心血管疾病(CVD),且以惊人的速度增长,对社会经济地位低下的人群影响尤为严重。肥胖对人体,尤其是对心血管系统有无数有害影响。肥胖是心力衰竭(HF)的主要风险因素,在这一人群中非常普遍,尤其是在射血分数保留型心力衰竭(HFpEF)患者中,以至于文献中提出了肥胖 HFpEF 表型。然而,一旦出现心房颤动,就会出现肥胖悖论,即肥胖患者的短期和中期存活率优于正常或体重过轻者。可以说,能量储备过多、患者年龄较小、对心房颤动治疗的耐受性较高以及营养状况较好至少是肥胖悖论的部分原因。此外,体重指数(BMI)可能并不能准确衡量身体成分,尤其是在高血脂患者中,因为他们的体积过大。体重指数也不能确定无脂肪质量及其组成部分,而无脂肪质量能更好地预测机能和心肺功能(CRF),尤其是在健康人和合并症患者中,CRF 被越来越多地认为是风险调节因素,特别是在心房颤动患者中。值得注意的是,如果考虑到心肺功能,肥胖悖论就会消失,这表明在高血压的治疗中,改善心肺功能可能是一个比改变体重更重要的治疗目标。在这篇叙述性综述中,我们讨论了当前肥胖的趋势、肥胖与高血压之间的因果关系、肥胖悖论的最新情况,并描述了肥胖人群中体重指数的主要缺陷。我们还概述了心房颤动治疗、减肥、CRF 的最新进展,以及这些治疗方法在心房颤动合并肥胖症患者中的应用。
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来源期刊
Progress in cardiovascular diseases
Progress in cardiovascular diseases 医学-心血管系统
CiteScore
10.90
自引率
6.60%
发文量
98
审稿时长
7 days
期刊介绍: Progress in Cardiovascular Diseases provides comprehensive coverage of a single topic related to heart and circulatory disorders in each issue. Some issues include special articles, definitive reviews that capture the state of the art in the management of particular clinical problems in cardiology.
期刊最新文献
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