心不全と併存疾患（慢性腎臓病、糖尿病、肥満）の管理、学際的アプローチ

Heart failure (HF) frequently coexists with chronic kidney disease (CKD), type 2 diabetes (T2D), and obesity, creating a complex clinical landscape that demands integrated care. The three main phenotypes of HF include heart failure with reduced ejection fraction (HFrEF, EF ≤40%), heart failure with mildly reduced ejection fraction (HFmrEF, EF 41-49%), and heart failure with preserved ejection fraction (HFpEF, EF ≥50%), each requiring distinct management approaches. Approximately 20-40% of patients with HF have T2D, while 30-40% are obese (Body Mass Index ≥30 kg/m²), and 45-63% have CKD. These comorbidities share bidirectional relationships with HF, exacerbating morbidity, mortality, and healthcare costs through overlapping pathophysiological mechanisms such as insulin resistance, chronic inflammation, neurohormonal activation, and endothelial dysfunction. Likewise, CKD, T2D, and obesity influence other common conditions in patients with HF, including anemia, sleep apnea, and atrial fibrillation. Effective evaluation and management of these conditions can have a cumulative effect, simultaneously improving the comorbidity burden and HF outcomes. A multidisciplinary team-cardiologists, primary care physicians, endocrinologists, nephrologists, pharmacists, dietitians, and mental health professionals-is critical for coordinating care, optimizing medical therapy, and addressing psychosocial barriers. However, clinical inertia, polypharmacy, and socioeconomic disparities hinder treatment adherence and medical therapy implementation. This review highlights the current evidence behind the management of common comorbid conditions in patients with HF.