Heart failure and obesity: novel insights leading to new treatment paradigms

Heart failure (HF) and obesity place a substantial burden on health-care systems worldwide. Obesity is associated with an estimated 5-7% increase in the incidence of new-onset HF for each unit increase in body mass index. This obesity-associated risk is more pronounced for HF with preserved ejection fraction than for HF with reduced ejection fraction. The relationship between HF and obesity has historically been underrecognized. However, because of the development of weight-loss drugs with beneficial effects on outcomes in patients with HF with preserved ejection fraction, this link is now clear. In this Review, we provide a summary of the effects of obesity on the development of HF, exploring the epidemiology and potential pathophysiological mechanisms linking these two conditions. We also discuss management strategies, including lifestyle interventions and novel pharmaceutical approaches. This Review adds an impetus to all practitioners of cardiovascular medicine, especially specialists in HF, to become well-versed in obesity management and underscores the need for further research on the effects of intentional weight loss in various cardiovascular conditions.