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Obesity and Heart Failure with Preserved Ejection Fraction
Efstratios Koutroumpakis1, Ramanjit Kaur1, Heinrich Taegtmeyer1
1Division of Cardiology, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, MSB 1.220, Houston, TX 77030, USA.
Heart Failure Clinics
|May 30, 2021
Summary
Obesity creates a unique heart failure with preserved ejection fraction (HFpEF) phenotype. Lifestyle changes and targeted medications show promise for improving outcomes in obese HFpEF patients.
Area of Science:
- Cardiology
- Metabolic Disorders
- Pulmonary Hypertension
Background:
- Obese heart failure with preserved ejection fraction (HFpEF) represents a distinct clinical phenotype.
- Key pathophysiological mechanisms include sodium retention, elevated neurohormones, altered metabolism, pulmonary hypertension, pericardial restraint, and inflammation.
Purpose of the Study:
- To summarize the distinct pathophysiological mechanisms of obese HFpEF.
- To highlight diagnostic challenges and potential therapeutic strategies for this specific patient group.
Main Methods:
- Review of current literature on the pathophysiology of obese HFpEF.
- Analysis of emerging treatment targets addressing obesity-related cardiovascular effects.
Main Results:
- Obesity significantly impacts HFpEF through mechanisms like sodium retention and inflammation.
- Reducing visceral adipose tissue via diet or surgery may improve outcomes.
- Pharmacological interventions targeting mineralocorticoid receptors, neprilysin, and SGLT2 show therapeutic potential.
Conclusions:
- Obese HFpEF is a complex condition requiring high clinical suspicion for diagnosis.
- Targeting visceral adiposity and employing specific pharmacotherapies offers new avenues for managing obese HFpEF.
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