Obesity paradox and heart failure
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REVIEW
Obesity paradox and heart failure Maria Pia Donataccio1 · Angiola Vanzo2 · Ottavio Bosello3 Received: 1 May 2020 / Accepted: 3 August 2020 © Springer Nature Switzerland AG 2020
Abstract Background There is scientific consensus that obesity increases the risk of cardiovascular diseases (CVD), including heart failure (HF). However, in CVD, many studies observed greater survival in overweight or class 1 obesity individuals. This counterintuitive observation was termed “obesity paradox” (OP). Objective and methods This article is a narrative overview of the relationship between OP and CVD, particularly HF. The sources used were MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library, from 2001 to 31 May 2020, exception for a 1983 work of historical importance. Studies reporting association and prognostic impact of obesity in HF and the impact of body composition on cardiac structure and myocardial function in obesity were also included in this review. In addition, we examined references from the retrieved articles and explored several related websites. Ultimately, we chose 79 relevant documents. Fifty-three were specifically focused on OP and HF. Results In this review, we made a summary of the evidence coming from a series of studies investigating OP. Many of these studies do not take into consideration or underestimate some of the more important morpho-functional variables of patients suffering from HF: among these, body composition and visceral adiposity, sarcopenic obesity, muscle fitness (MF), and cardiorespiratory fitness (CRF). A high body mass index (BMI) represents a risk factor for HF, but it also seems to exert a protective effect under certain circumstances. Fat distribution, lean mass, and cardio fitness could play an essential role in determining the observed differences in the HF population. Conclusion BMI does not distinguish between the metabolically healthy and metabolically unhealthy obesity. The obesity impact on morbidity and premature mortality can be underestimated and, therefore, may lead to incorrect clinical courses. Level of evidence Level V, Narrative review. Keywords Obesity paradox · Heart failure · Cardiovascular disease · Fitness · Body composition Abbreviations AHF Acute heart failure AMI Acute myocardial infarction BIA Bioelectrical impedance analysis of body composition BF Body fat CAD Coronary artery disease CHF Chronic heart failure CRF Cardiorespiratory fitness The article is part of the Topical collection on Obesity paradox. * Ottavio Bosello [email protected] 1
Cardiology Unit, European Hospital, Rome, Italy
2
Department of Internal Medicine, University of Verona, Verona, Italy
3
SIAN, AULSS 8, Vicenza, Veneto, Italy
CVD Cardiovascular disease ET Exercise training HF Heart failure HFpEF HF with preserved ejection fraction HFrEF HF with reduced ejection fraction LBM Lean body mass LM Lean mass MET Metabolic equivalent MI Myocardial infarction MF Muscular fitness MNOB Metabolically normal obese MAOB Metabolically abnormal obese M
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