Obesity and Heart Failure: Introducing the Theme.

Area of Science:

• Cardiology
• Endocrinology
• Metabolic Disease

Background:

• Obesity is a prevalent chronic disease and a major risk factor for heart failure (HF), especially HF with preserved ejection fraction (HFpEF).
• Excess adipose tissue, particularly epicardial adipose tissue (EAT), drives inflammation, oxidative stress, and myocardial remodeling, contributing to HFpEF pathophysiology.
• A direct relationship exists between increasing body mass index and HF incidence.

Purpose of the Study:

• To explore the mechanisms by which obesity contributes to HFpEF.
• To review current and emerging therapeutic strategies for obesity-related HFpEF.
• To emphasize the need for integrated treatment approaches addressing both HF and obesity.

Main Methods:

• Review of existing literature on obesity, HFpEF, and therapeutic interventions.
• Analysis of the role of adipose tissue in cardiac dysfunction.
• Evaluation of pharmacological treatments for HF and obesity.

Main Results:

• Obesity-related HFpEF presents with specific clinical characteristics like concentric left ventricular hypertrophy and impaired relaxation.
• Traditional HF medications remain foundational, targeting hemodynamic and neurohormonal pathways.
• Emerging therapies, including SGLT2 inhibitors and GLP-1 receptor agonists, demonstrate efficacy in reducing HF hospitalizations, promoting weight loss, and showing anti-remodeling effects.

Conclusions:

• Obesity-driven HF is a distinct cardiometabolic entity requiring tailored management.
• Integrated therapeutic strategies combining weight reduction with guideline-directed HF therapy are crucial.
• Addressing upstream adiposity-related mechanisms alongside hemodynamic burden offers a promising approach to managing obesity-related HFpEF.