Does Weight Loss Improve Clinical Outcomes in Overweight and Obese Patients with Heart Failure?
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OBESITY (KM GADDE AND P SINGH, SECTION EDITORS)
Does Weight Loss Improve Clinical Outcomes in Overweight and Obese Patients with Heart Failure? Thida Tabucanon 1,2 & Jennifer Wilcox 3 & W. H. Wilson Tang 1,3 Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Obesity increases the risk of new onset heart failure (HF), and particularly HF with preserved ejection fraction (HFpEF). Despite the observations of favorable clinical outcomes in HF patients with obesity in general, sometimes referred to as the “obesity paradox,” it is important to recognize that severe obesity is associated with worse clinical outcomes. This review summarizes the effects of obesity treatment on cardiovascular health and HF clinical outcomes. Recent Findings Treatment for obesity utilizes a variety of modalities to achieve purposeful weight loss including lifestyle intervention, medications, and bariatric surgery. There are a cluster of benefits of obesity treatment in terms of clinical outcomes in HF. The mechanisms of these benefits include both weight loss-dependent and weight loss-independent mechanisms. Summary Obesity treatment is safe and associated with favorable clinical outcomes across the spectrum of the HF population. The potential benefits are facilitated through multiple mechanisms. Keywords Obesity paradox . Heart failure in diabetes . Preserved ejection fraction
Introduction Obesity, often defined as a body mass index (BMI) ≥ 30 kg/ m2, continues to increase in the USA and worldwide. The prevalence of obesity in the USA approximately tripled from 13.4% in 1960–1962 to 39.6% in 2015–2016 [1, 2]. Obesity is associated with an increased risk of traditional cardiovascular (CV) risk factors like hypertension (HTN) and diabetes mellitus (DM), and adverse structural, functional, and hemodynamic changes of the heart [3, 4]. Heart failure is a complex disease with the prevalence of heart failure (HF) has been increasing over time. The data from the National Health and
Nutrition Examination Survey (NHANES) 2013–2016 showed an estimated 6.25 million adult Americans had HF, an increase from 5.7 million from the NHANES 2009–2012 [5]. Obesity treatment, regardless of weight loss, has shown numerous benefits in HF patients, with improvements in metabolic function, hemodynamics, cardiac structure and function, quality of life (QOL), exercise capacity, and a reduction in CV risk factors [6••, 7••, 8, 9•, 10]. Although the underlying mechanisms of these positive changes have been previously presumed to be secondary to weight loss, recent evidence supports a weight loss-independent mechanism.
This article is part of the Topical Collection on Obesity
Obesity and Heart Failure
* W. H. Wilson Tang [email protected]
Obesity is a major risk factor for HF development, particularly for HF with preserved ejection fraction (HFpEF), and has a well-established association with other HF risk factors such as HTN, coronary artery disease (CAD), atrial fibrillation (AF), DM, and obstruc
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