Implications of obesity across the heart failure continuum

Abstract

The obesity paradox, which suggests a survival advantage for the obese in heart failure (HF) has sparked debate in the medical community. Studies demonstrate a survival advantage in obese patients with HF, including those with advanced HF requiring continuous inotropic support for palliation or disease modifying therapy with a left ventricular assist device (LVAD) or heart transplantation (HT). Importantly, the obesity paradox is affected by the level of cardiorespiratory fitness (CRF). It is now recommended that HF patients with body mass index ≥35 kg/m 2 achieve at least 5–10% weight loss, in order to improve symptoms and cardiac function, though more robust data are urgently needed. CRF may be the single best predictor of overall health and small improvements in fitness levels may lead to improved outcomes in HF. In addition to implications of obesity in chronic HF, we also discuss management of obese patients with advanced HF and their implications for therapies such as LVAD implantation and HT.

The Obesity Paradox in Infections and Implications for COVID-19

“…4 Ironically, despite the increased health risks associated with obesity, patients with obesity and CVD have better short-and medium-term prognoses than do leaner patients with the same degree of CVD. 2,3,5 Termed the obesity paradox, these prognostic benefits have also been seen in end-stage renal disease 6 and respiratory diseases, including chronic obstructive pulmonary disease (COPD), 7 as well as in PE. 8 In this issue of the Mayo Clinic Proceedings, Gribsholt et al 9 report the mortality of patients who were hospitalized between January 1, 2011, and September 30, 2015, for noneCOVID-related infections of varied sources: sepsis, pulmonary, urinary, and skin.…”

Adipose Tissue-Endothelial Cell Interactions in Obesity-Induced Endothelial Dysfunction

“…Large-scale epidemiological studies have questioned the exact nature of adiposity-adverse outcomes association, implicating an "obesity paradox, " in which individuals with overweight and even obesity present survival benefit compared with their normal-weight counterparts in general population and those with chronic diseases (79,80) or critical illness (e.g., heart failure) (74)(75)(76)(77)(78). Although under debate (81), the survival benefits may be attributable to higher energy reserves, inflammatory preconditioning, endotoxin neutralization, adrenal steroid synthesis, activation of RAS, secretion of cardioprotective factors, and prevention of muscle wasting (82). Given the methodological flaws in these studies, further randomized and controlled clinical trials and prospective studies are required to validate the concept.…”

Regional adiposity, cardiorespiratory fitness, and left ventricular strain: an analysis from the Dallas Heart Study

“…Our study findings have important clinical implications. The independent associations of higher VAT and lower CRF with subclinical abnormalities in LV contractility highlight their potential role as modifiable targets for HF prevention [ 44 , 45 ]. Observational studies of individuals who have undergone bariatric surgery suggest that substantial weight loss can reverse pathological cardiac remodeling and reduce risk of incident HF[ 46 , 47 ].…”