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Obesity paradox and heart failure.
Maria Pia Donataccio1, Angiola Vanzo2, Ottavio Bosello3
1Cardiology Unit, European Hospital, Rome, Italy.
Eating and Weight Disorders : EWD
|August 28, 2020
Summary
The obesity paradox shows overweight individuals with heart failure (HF) may survive longer. However, body composition and fitness, not just BMI, influence HF outcomes.
Area of Science:
- Cardiology
- Obesity Medicine
- Public Health
Background:
- Obesity is a known risk factor for cardiovascular diseases (CVD), including heart failure (HF).
- The
- obesity paradox
- describes the counterintuitive finding of greater survival in overweight or class 1 obesity individuals with CVD.
- This review examines the complex relationship between obesity and HF outcomes.
Purpose of the Study:
- To provide a narrative overview of the obesity paradox in cardiovascular disease, particularly heart failure.
- To synthesize evidence on the prognostic impact of obesity and body composition in HF patients.
- To explore the influence of body composition on cardiac structure and myocardial function in obesity.
Main Methods:
- A narrative review of literature from MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library (2001-2020).
- Included studies on obesity, HF, body composition, and cardiac function.
- Examined references from retrieved articles and related websites, selecting 79 relevant documents (53 on obesity paradox and HF).
Main Results:
- Many studies investigating the obesity paradox in HF underestimate key morpho-functional variables.
- Variables such as body composition, visceral adiposity, sarcopenic obesity, muscle fitness (MF), and cardiorespiratory fitness (CRF) are crucial.
- While high BMI is a risk factor for HF, it may offer a protective effect in specific contexts, influenced by fat distribution, lean mass, and cardio fitness.
Conclusions:
- Body Mass Index (BMI) alone does not differentiate between metabolically healthy and unhealthy obesity.
- The impact of obesity on morbidity and premature mortality in HF may be underestimated.
- This underestimation can lead to inappropriate clinical management and treatment decisions.
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