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Sex and central obesity in heart failure with preserved ejection fraction

Hidemi Sorimachi1, Kazunori Omote1, Massar Omar1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.

European Journal of Heart Failure
|May 23, 2022
PubMed

Insights

Central obesity significantly impacts heart failure with preserved ejection fraction (HFpEF), especially in women. This condition is linked to worse metabolic and hemodynamic profiles, with distinct sex-based differences observed in HFpEF patients.

Area of Science:

  • Cardiology
  • Metabolic Syndrome
  • Obesity Research

Background:

  • Obesity is a known risk factor for heart failure with preserved ejection fraction (HFpEF).
  • The specific mechanisms linking obesity, particularly central adiposity, to HFpEF remain unclear.
  • There is a particular concern regarding the impact of obesity on HFpEF in women.

Purpose of the Study:

  • To investigate the impact of central adiposity in patients diagnosed with HFpEF.
  • To explore potential sex differences in the relationship between central adiposity and HFpEF.
  • To analyze the association between central obesity and hemodynamic responses during exercise in HFpEF.

Main Methods:

  • Invasive hemodynamic exercise testing and rest echocardiography were performed on 124 women and 105 men with HFpEF.
  • Central obesity was defined by waist circumference (WC) thresholds (≥88 cm for women, ≥102 cm for men).
  • Exercise-normalized pulmonary capillary wedge pressure (PCWP) responses were assessed using PCWP/Workload (PCWP/W) and PCWL ratios.

Main Results:

  • Central obesity (77%) was more prevalent than general obesity (62%) in the HFpEF cohort.
  • Patients with central obesity exhibited higher diabetes and dyslipidemia prevalence, elevated heart and pulmonary pressures, and reduced aerobic capacity.
  • Associations between WC and metabolic/hemodynamic parameters were observed in women but not men, with stronger correlations in women.

Conclusions:

  • Central obesity is highly prevalent in HFpEF and more common than general obesity.
  • Significant sexual dimorphisms exist in the relationship between central obesity and metabolic/hemodynamic abnormalities in HFpEF.
  • Central obesity appears to have a greater adverse impact on women with HFpEF compared to men.
Abstract

Keywords:
Central obesityHeart failureWaist circumference

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