'Obesity Paradox' in HF Examined in New Comprehensive Review

Obesity induces adverse changes in arterial blood pressure (BP), and cardiac structure and function. It is also a well-established risk factor for various cardiovascular diseases, including hypertension, coronary artery disease and heart failure (HF). However, obesity is not necessarily a predictor of poor outcomes among patients with cardiovascular disease. Many studies have reported an "obesity paradox" in that obese patients with cardiovascular disease (CVD) have better prognoses than their lean counterparts. These issues and others related to obesity in CVD are the topic of a new review published April 1 in JACC Heart Failure.

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Lead author Carl J. Lavie, MD, FACC, University of Queensland School of Medicine, New Orleans, and colleagues, describe the hemodynamic alterations that occur in obese and overweight people, and the pathological effects of these changes on BP, and cardiac structure and function, and the subsequent development of CVD and poor prognoses for patients. The review also addresses how obesity may influence prognosis in HF and the role of cardiopulmonary exercise testing, as well as its impact on heart transplantation and the functioning of left ventricular assist devices.

The authors note that diagnosing HF and assessing the prognosis of HF in obese patients is difficult. Obese patients are more likely to have dyspnea and other non-specific symptoms suggestive of heart failure and other types of CVD.

"Performing an exertional assessment may assist in the diagnosis of heart failure, and if confirmed, clearly portends prognostic value," the authors write. Cardiopulmonary exercise testing is the “gold-standard aerobic assessment and a clinical standard in patients with HF … [and] is perhaps one of the most valuable assessment tools.”

The article concludes with an assessment of the value of intentional weight reduction in patients with HF. "Weight reduction clearly has beneficial effects on cardiac structure and function, but only limited data are available to base current recommendations for intentional weight loss in HF," the authors note. "Nevertheless, we feel that the 'weight' of evidence supports intentional weight reduction in HF," they add.

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