Hypertension, Obesity, Diabetes, Hyperlipidemia, and Metabolic Syndrome in Heart Failure

Bozkurt B, Aguilar D, Deswal A, et al.
Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2016;Oct 31:[Epub ahead of print].

The following are key points to remember from this American Heart Association Scientific Statement on Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure:

  1. Hypertension
    • There are no compelling data to justify a single blood pressure target in treating hypertension in patients with established heart failure.
    • Paradox: Although hypertension results in the development of heart failure, once advanced systolic heart failure is manifest, lower blood pressure is associated with a worse prognosis, and higher blood pressure is associated with a better prognosis.
  2. Obesity
    • Obesity paradox: Although obesity is well established as a risk factor for cardiovascular disease and incident heart failure, obesity is not a risk factor for adverse outcomes in patients with established heart failure.
    • Sibutramine and ephedra weight loss preparations may contribute to the development of heart failure and should be avoided.
    • Small short-term studies have suggested that therapy of obstructive sleep apnea with continuous positive airway pressure is associated with an improvement in left ventricular ejection fraction, dyspnea, and quality of life in systolic HF patients.
  3. Diabetes Mellitus
    • Despite the epidemiological data linking worse glycemic control to greater rates of heart failure in observational studies and clinical trials, data from randomized, controlled, clinical trials of more intensive glucose control have not demonstrated a benefit in heart failure reduction with intensive glycemic control.
    • Caution is urged for the use of thiazolidinediones in all patients with signs and symptoms of congestive heart failure. Initiation of these agents is contraindicated in patients with New York Heart Association (NYHA) class III or IV heart failure.
  4. Hyperlipidemia
    • In patients with established heart failure (unlike in the general population), several analyses have now demonstrated an inverse relationship between cholesterol levels and outcome. In light of this inverse relationship between cholesterol levels and mortality in patients with HF, it is unknown whether the cholesterol treatment goals recommended for the general population and patients with atherosclerotic cardiovascular disease apply to patients with heart failure, and remain to be determined.
    • In stage C and D heart failure, N-polyunsaturated fatty acid (PUFA) supplementation is reasonable to use as adjunctive therapy in systolic or diastolic heart failure patients with NYHA class II-IV symptoms and, unless contraindicated, to reduce mortality and cardiovascular hospitalizations. Statins, however, are not beneficial as adjunctive therapy when prescribed solely for the diagnosis of heart failure in the absence of other indications.
  5. Metabolic Syndrome
    • Metabolic syndrome may exert an inverse association with improved survival in the heart failure population. Further studies are warranted to confirm and better understand this paradox.
  6. Lifestyle Modifications
    • Lifestyle modifications for a heart failure patient include several approaches such as losing or maintaining normal weight, tracking daily fluid intake, avoiding alcohol, avoiding or limiting caffeine, eating a heart-healthy diet, being physically active, exercising, managing stress, keeping track of and monitoring blood pressure, getting adequate rest, developing support, and avoiding flu and pneumonia with vaccinations.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Nonstatins, Acute Heart Failure, Chronic Heart Failure, Diet, Hypertension, Sleep Apnea

Keywords: Blood Pressure, Cholesterol, Comorbidity, Diabetes Mellitus, Diet, Dyslipidemias, Ephedra, Glucose, Heart Failure, Heart Failure, Systolic, Heart Failure, Diastolic, Hyperlipidemias, Hypertension, Metabolic Syndrome X, Obesity, Pneumonia, Primary Prevention, Quality of Life, Risk Factors, Sleep Apnea, Obstructive, Stroke Volume, Thiazolidinediones, Vaccines, Weight Loss

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