Weight Reduction for Obesity-Induced Heart Failure with Preserved Ejection Fraction
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HYPERTENSION AND OBESITY (E REISIN, SECTION EDITOR)
Weight Reduction for Obesity-Induced Heart Failure with Preserved Ejection Fraction Karnika Ayinapudi 1 & Rohan Samson 1 & Thierry H. Le Jemtel 1 & Nassir F. Marrouche 1 & Suzanne Oparil 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Heart failure with preserved ejection fraction mainly affects the elderly. The obesity phenotype of heart failure with preserved ejection fraction reflects the coexistence of two highly prevalent conditions in the elderly. Obesity may also lead to heart failure with preserved ejection fraction in middle-aged persons, especially in African American women. Recent Findings Obesity is twice as common in middle-aged than in elderly persons with heart failure with preserved ejection fraction. Obese middle-aged persons with heart failure with preserved ejection fraction are less likely to be Caucasian and to have atrial fibrillation or chronic kidney disease as comorbidities than elderly patients with heart failure with preserved ejection fraction. Obesity-associated low-grade systemic inflammation may induce/heighten inflammatory activation of the coronary microvascular endothelium, leading to cardiomyocyte hypertrophy/ stiffness, myocardial fibrosis, and left ventricular diastolic dysfunction. Summary Both substantial weight reduction with bariatric surgery and lesser levels of weight reduction with caloric restriction are promising therapeutic approaches to obesity-induced heart failure with preserved ejection fraction. Keywords Obesity . Heart failure with preserved ejection fraction . Adipose tissue . Bariatric surgery . Caloric restriction
Introduction The obesity epidemic is leveling off in men but continues to progress in women [1]. Furthermore, the prevalence of morbid obesity (body mass index [BMI] ≥ 40 kg/m2) is growing at a faster rate than that of obesity as a whole [2]. Obesity and morbid obesity are associated with changes in left ventricular (LV) structure and function, most commonly concentric remodeling and diastolic dysfunction [3–6]. LV concentric remodeling and diastolic dysfunction (LVDD) are the underpinnings of heart failure with preserved ejection fraction (HFpEF). A likely corollary of the obesity epidemic is the increasing incidence of HFpEF, particularly in women and This article is part of the Topical Collection on Hypertension and Obesity * Thierry H. Le Jemtel [email protected] 1
Tulane University Heart and Vascular Institute, 1430 Tulane Ave, SL-48, New Orleans, LA 70112, USA
2
Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, LA, USA
African Americans [7, 8••, 9]. We review how obesity, female sex, and African American ethnicity may affect the incidence and outcome of HFpEF. We then consider how obesity fosters the development of HFpEF and surgical versus non-surgical approaches to weight reduction.
Obesity and Heart Failure with Preserved Ejection
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