Obesity: the perfect storm for heart failure

ESC Heart Failure, Journal Year: 2024, Volume and Issue: 11(4), P. 1841 - 1860

Published: March 15, 2024

Abstract Obesity condition causes morphological and functional alterations involving the cardiovascular system. These can represent substrates for different diseases, such as atrial fibrillation, coronary artery disease, sudden cardiac death, heart failure (HF) with both preserved ejection fraction (EF) reduced EF. Different pathogenetic mechanisms may help to explain association between obesity HF including left ventricular remodelling epicardial fat accumulation, endothelial dysfunction, microvascular dysfunction. Multi‐imaging modalities are required appropriate recognition of subclinical systolic dysfunction typically associated obesity, echocardiography being most cost‐effective technique. Therapeutic approach in patients is challenging, particularly regarding EF which few strategies high level evidence available. Weight loss extreme importance HF, a primary therapeutic intervention. Sodium–glucose co‐transporter‐2 inhibitors have been recently introduced novel tool management patients. The present review aims at analysing recent studies supporting pathogenesis, diagnosis, HF.

Language: Английский

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The Quality of Life in Heart Failure Reduced Ejection Fraction (HFrEF) Patients: A Phenomenon of Obesity Paradox

GHMJ (Global Health Management Journal), Journal Year: 2025, Volume and Issue: 8(1), P. 23 - 30

Published: Jan. 10, 2025

Background: Obesity place patients at risk of cardiovascular disease (CVD). There may be an inverse relationship between obesity and CVD prognosis-a phenomenon known as the “obesity paradox”. Obese HF might have a better prognosis, especially in terms quality life (QoL). Aims: The purpose this study was to examine QoL based on classification. Methods: This cross-sectional conducted clinic Hasna Medika Cardiovascular Hospital, Cirebon, Indonesia. Samples were HFrEF who had received medication for least 6 months patient must optimal guidelines directed medical therapy (GDMT) with 3 pillar drugs according Indonesian heart failure guidelines. Inclusion criteria ejection fraction <40% echocardiographic examination. Exclusion motor impairments, such post-stroke, severe osteoarthritis, paralysis, did not receive GDMT. Results: A total 40.3% sample obese, 9.7% underweight 67.5% central obesity. Coronary artery (89.6%), smoking (67.5%) hypertension (49.4%) most common comorbidities factors found. About 12.3% experienced rehospitalization times year. Based Kansas City Cardiomyopathy Questionnaire (KCCQ)-12, about 3.2% poor QoL, 55.8% good excellent QoL. proportion 66.7% obese 20% overweight. While there no 80%. Meanwhile, 65.1% obese. Conclusion: outcomes. is called paradox. important goal management addition reducing mortality. Received: 02 December 2024 | Reviewed: 17 Revised: 24 Accepted: 10 January 2025.

Language: Английский

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Treatment options for heart failure in individuals with overweight or obesity: a review

Future Cardiology, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 15

Published: March 18, 2025

Obesity and heart failure are interlaced global epidemics, each contributing to significant morbidity mortality. is not only a risk-factor for failure, but also complicates its management, by distinctive pathophysiological mechanisms cumulative comorbidities, requiring tailored treatment plan. To present current options in individuals with overweight/obesity, emphasizing available pharmacological therapies, non-pharmacological strategies, the management of related comorbidities. We conducted comprehensive literature review regarding results treatments including cornerstone interventions as well emerging therapeutic options. Specific drug classes, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, sodium-glucose cotransporter-2 have demonstrated consistent efficacy irrespective body mass index, while diuretics remain key fluid management. Glucagon-like peptide-1 agonists shown promising improving relevant outcomes warrant further research. Non-pharmacological approaches, weight-loss strategies lifestyle modifications, improve symptoms, exercise tolerance quality life. Managing overweight/obesity requires multidisciplinary, individualized approach integrating Emerging therapies preventive arise address unique challenges this population provide improved outcomes.

Language: Английский

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Histone H2A: a promising diagnostic marker in heart failure with reduced versus preserved ejection fraction

Molecular and Cellular Biochemistry, Journal Year: 2025, Volume and Issue: unknown

Published: March 22, 2025

Language: Английский

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Obesity and inflammation in chronic and acute heart failure

Heart Failure Reviews, Journal Year: 2025, Volume and Issue: unknown

Published: May 3, 2025

Language: Английский

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Association of Body Mass Index with Outcomes in Patients with Heart Failure with Reduced Ejection Fraction (HFrEF)

Nutrients, Journal Year: 2024, Volume and Issue: 16(15), P. 2473 - 2473

Published: July 30, 2024

Heart failure (HF) is a major health issue, affecting up to 2% of the adult population worldwide. Given increasing prevalence obesity and its association with various cardiovascular diseases, understanding role in HFrEF outcomes crucial. This study aimed investigate impact on in-hospital mortality prolonged hospital stay patients heart reduced ejection fraction (HFrEF). We conducted retrospective analysis 425 admitted cardiology unit at University Clinical Hospital Wroclaw, Poland, between August 2018 2020. Statistical analyses were performed evaluate interactions BMI, sex, comorbidities mortality. Significant found sex BMI as well post-stroke status, Specifically, increased was associated decreased odds males (OR = 0.72, 95% CI: 0.55–0.94, p < 0.05) but higher females 1.18, 0.98–1.42, 0.08). For without history stroke, (HR 0.78, 0.64–0.95, 0.01), whereas effect less pronounced those stroke 0.89, 0.76–1.04, 0.12). In conclusion, significantly each 10% increase for males, females, death. Additionally, more cerebral (CS) compared CS. These findings should be interpreted caution due low number observed potential sex.

Language: Английский

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Association between Obesity and Atrial Function in Patients with Non-Valvular Atrial Fibrillation: An Echocardiographic Study

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(10), P. 2895 - 2895

Published: May 14, 2024

Background: Obesity is a public health problem which prevalence has increased worldwide and associated with different degrees of hemodynamic alterations structural cardiac changes. The aim the study to investigate impact body mass index (BMI) on left atrial function using standard advanced echocardiography in population patients non-valvular fibrillation (AF). Methods: 395 adult suffering from AF, divided into three tertiles based BMI value, carry out cardiological examination echocardiography. Results: Peak longitudinal strain (PALS), measure function, lower tertile highest (14.3 ± 8.2%) compared both first (19 11.5%) second (17.7 10.6%) statistically significant manner (p < 0.002). Furthermore, significantly independent PALS by multilinear regression analysis, even after correction data for CHA2DS2-VASc score, ventricular index, ejection fraction, E/E' ratio systolic pulmonary arterial pressure (coefficient standardized β = -0.127, p 0.02; Cumulative R2 0.41, SEE 0.8%, 0.0001). Conclusions: could be considered an additional factor assessing cardiovascular risk fibrillation, addition well-known score.

Language: Английский

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Detecting heart stress using NT-proBNP in patients with type 2 diabetes mellitus and hypertension or high-normal blood pressure: a cross-sectional multicentric study

Cardiovascular Diabetology, Journal Year: 2024, Volume and Issue: 23(1)

Published: Aug. 12, 2024

Abstract Background We evaluated the prevalence of “heart stress” (HS) based on NT-proBNP cut-points proposed by 2023 Consensus Heart Failure Association (HFA) European Society Cardiology (ESC) in asymptomatic patients with T2DM and hypertension or high-normal blood pressure (BP) eligible for SGLT2 inhibitors (SGLT2i) and/or GLP-1 receptor agonists (GLP1-RA), drugs proven benefits reducing incidence HF, hospitalizations, cardiovascular events mortality. Methods A cross-sectional multicentric study was conducted 192 consecutive outpatients, aged ≥ 55 years, BP, referred to three diabetology units. collected before starting new anti-diabetic therapy. Patients known HF were excluded, participants classified age-adjusted cut-points. Results Mean age: 70.3 ± 7.8 years (67.5% males). obesity (BMI 30 Kg/m 2 ): 63.8%. Median NT-proBNP: 96.0 (38.8–213.0) pg/mL. Prevalence chronic kidney disease (CKD, eGFR < 60 mL/min/1.73m 32.1%. arterial BP: 138.5/77.0 15.8/9.9 mmHg. The values, according cut-points, 28.6% as “HS likely” (organize elective echocardiography specialist evaluation), 43.2% not (a grey area, repeat at six months) 28.2% “very unlikely HS” (repeat one year). presence CKD number anti-hypertensive drugs, but glycemic parameters, independently associated HS. Conclusions According NT-proBNP, over a quarter hypertension/high-normal among those SGLT2i GLP1-RA, already risk cardiac damage, even subclinical. Most would receive an indication echocardiogram be specialist, allowing early implementation effective strategies prevent delay progression advanced stages overt HF.

Language: Английский

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Role of epicardial adipose tissue in cardiac remodeling

Diabetes Research and Clinical Practice, Journal Year: 2024, Volume and Issue: unknown, P. 111878 - 111878

Published: Oct. 1, 2024

Language: Английский

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Reframing the role of glucagon‐like peptide 1 receptor agonists in cardiovascular medicine

ESC Heart Failure, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 15, 2024

In recent years, there has been growing evidence of the beneficial role glucagon-like peptide 1 receptor agonists (GLP1-RA) in treatment obesity, type 2 diabetes (T2D) and prevention cardiovascular (CV) disease.1, Across large randomized clinical trials, GLP1-RAs showed a 14% [hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.80 to 0.93] risk reduction major adverse events [MACE (myocardial infarction, stroke, or CV death)], 12% death, hospitalization for heart failure (HF) among patients with T2D.1 International guidelines have since recommended use GLP-1 T2D subclinical/clinical disease, overweight/obesity, both.3 Recently, GLP1-RA supplemented by trials exploring efficacy semaglutide both non-diabetic diabetic obese HF preserved ejection fraction (HFpEF) (the STEP-HFpEF trial DM trial, respectively)4 different profiles but without SELECT Trial).5 The enrolled LVEF (left ventricular fraction) ≥45% body mass index (BMI) ≥30 kg/m2. Patients were receive 2.4 mg subcutaneous once weekly placebo.4 pooled analysis, significantly improved HF-related symptoms (+7.5 points estimated difference) reduced weight ~8%. Although not designed assess events, fewer hospitalizations semaglutide-treated as compared placebo. analysis also robust safety data. Fewer serious cardiac disorders infectious disease recorded group than placebo group. Gastrointestinal leading discontinuation more common group, although frequency gastrointestinal including pancreatitis, was similar groups. It's important however highlight that selected data on are needed from general population. Semaglutide Effects Cardiovascular Outcomes People Overweight Obesity (SELECT) trial,5 administration (weekly dose mg) standard care overweight obesity pre-existing (82% history coronary artery disease) led 20% composite death causes, nonfatal MI, stroke (HR, 0.80; CI, 0.72 0.90). Results consistent previous SUSTAIN-6 which 26% 0.74; 0.58 0.95) treated weekly.6 This is first benefit derived using even findings open new perspectives this class drug broad context prevention. Previous suggested effect may differ according phenotype an attenuated those LVEF, raising concerns about its patients.7 Indeed, secondary FIGHT profile Liraglutide HFrEF less pronounced.8 shed light enrolling 1300 HFrEF. A prespecified benefits terms mortality irrespective investigator-reported subtype.9 Yet, dedicated clarify hard endpoints across full spectrum LVEF.10 did specifically include elevated natriuretic peptides, potentially biasing rate restricting generalizability post hoc analysis. Taken together, targeted widely encountered practice US Europe millions suffer concomitant other factors/comorbidities. When lifestyle pharmacologic interventions overweight/obesity show clear MACE reduction, early suggesting magnitude body-weight loss mediated only part benefit. For instance, Harmony albiglutide had modest glycaemic control loss, it associated 22% events.2 potential barrier medical therapy implementation derive formulation explored trials. While effective recently chronic kidney FLOW trial,11 higher dosage (2.4 weekly) programme. meta-analysis SELECT, programme, favourable regardless regimens HFpEF patients.12 oral available, molecules under development, most outcome regimen. PIONEER 6 resulted significant noninferior outcomes T2D.13 More therefore provide well. exact underlying pharmacological mechanisms GLP1-RA, beyond entirely elucidated. Analysis programme consistently NT-proBNP participants baseline degree experienced larger reductions physical limitations semaglutide. effects improve remodelling respect left atrial volume, LV diastolic function right size.14, 15 these suggest observed unlikely be simply related underlie specific disease-modifying effects. thought contribute inflammation endothelial myocardial improvement, promotion atherosclerotic plaque stability platelet aggregation.2, 16 GLP receptors indeed expressed myocardium blood vessels. context, stimulation increase cellular glucose uptake function, favour vasodilation, inhibition smooth muscle cells proliferation flow. Thus, wide metabolic protective may, at least part, explain (Figure 1). Beyond available novel combined glucose-dependent insulinotropic polypeptide (GIP-RA) tirzepatide will further pathophysiological evidence. Tirzepatide approved dual GIP RA lowering indication management adults preobesity. SURMOUNT Programme overall ranging T2D.17 Finally, SUMMIT (NCT04847557) 38% (HF urgent visit hospitalization, diuretic intensification death), 15.7% improvement health status (LVEF ≥ 50%) ongoing SURPASS CVOT (NCT04255433) SURMOUNT-MMO (NCT05556512) test diabetes, respectively. results must considered public issue requiring need tackle burden presence diabetes. Despite proven directed such sodium-glucose cotransporter inhibitors, residual morbidity mortality.18, 19 There implement therapeutic agents along established preventive lifestyle20 interventions. Overall, emergence GIP/GLP-1 agonist offer opportunities optimize symptom obesity. behaviour, dietary modifications activity, should form bedrock plan pursued when patient medications surgical options. Obese high polypharmacy, enhancing drugs interaction side Also, initiation, up-titration monitoring GLP-RA carefully monitored especially avoid Given multiple comorbidities complex multidisciplinary team includes nurses, pharmacists, cardiologists, dietitians diabetologists, appears critical order strategies. Medication access remains one notable barriers initiating pharmacotherapies. cost limits accessibility worldwide. Public policy regulatory agencies called social needs treatments GLP1-RA. At same time, future required determine entire expand disease.

Language: Английский

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