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Author Spotlight: Exploring the Relationship Between Lipotoxicity and HFpEF
Published on: March 29, 2024
Obesity: the perfect storm for heart failure
Maria Lembo1, Teresa Strisciuglio1, Celeste Fonderico1
1Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy.
Insights
Obesity significantly impacts cardiovascular health, leading to heart failure (HF). Weight loss and new treatments like sodium-glucose co-transporter-2 inhibitors are crucial for managing obesity-related HF.
Area of Science:
- Cardiology
- Metabolic Disorders
- Medical Imaging
Background:
- Obesity causes cardiovascular alterations, increasing risks for conditions like atrial fibrillation, coronary artery disease, and heart failure (HF).
- Mechanisms linking obesity and HF include left ventricular remodeling, epicardial fat, endothelial dysfunction, and coronary microvascular dysfunction.
Purpose of the Study:
- To review recent studies on the pathogenesis, diagnosis, and management of heart failure in obese patients.
- To highlight the challenges in treating obesity-related HF, especially HF with preserved ejection fraction (HFpEF).
Main Methods:
- Literature review of recent studies on obesity and heart failure.
- Analysis of multi-imaging modalities for diagnosing subclinical systolic dysfunction.
- Evaluation of therapeutic strategies, including weight loss and pharmacotherapy.
Main Results:
- Echocardiography is a cost-effective method for detecting obesity-associated subclinical systolic dysfunction.
- Weight loss is a primary therapeutic intervention for patients with obesity and HF.
- Sodium-glucose co-transporter-2 inhibitors represent a novel therapeutic option for HF management.
Conclusions:
- Obesity presents complex challenges in HF management, particularly for HFpEF.
- Integrated approaches focusing on weight reduction and emerging pharmacological agents are essential.
- Further research is needed to optimize treatment strategies for obesity-related cardiovascular diseases.
Abstract:
Obesity condition causes morphological and functional alterations involving the cardiovascular system. These can represent the substrates for different cardiovascular diseases, such as atrial fibrillation, coronary artery disease, sudden cardiac death, and heart failure (HF) with both preserved ejection fraction (EF) and reduced EF. Different pathogenetic mechanisms may help to explain the association between obesity and HF including left ventricular remodelling and epicardial fat accumulation, endothelial dysfunction, and coronary microvascular dysfunction. Multi-imaging modalities are required for appropriate recognition of subclinical systolic dysfunction typically associated with obesity, with echocardiography being the most cost-effective technique. Therapeutic approach in patients with obesity and HF is challenging, particularly regarding patients with preserved EF in which few strategies with high level of evidence are available. Weight loss is of extreme importance in patients with obesity and HF, being a primary therapeutic intervention. Sodium-glucose co-transporter-2 inhibitors have been recently introduced as a novel tool in the management of HF patients. The present review aims at analysing the most recent studies supporting pathogenesis, diagnosis, and management in patients with obesity and HF.
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