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减肥作为预防和治疗心力衰竭的最佳心脏代谢管理策略
Thomaz Alexandre Costa1, Amanda R Vest2, Josephine Harrington1,3
1Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
Current opinion in cardiology
|March 9, 2026
概括
蓄意减肥对心力衰竭有保存在喷射分数 (HFpEF) 的治疗有希望,改善生活质量和运动能力. 需要进一步的研究来确认其在其他类型的心力衰竭和初级预防中所带来的益处.
科学领域:
- 心脏病学 心脏病学
- 代谢综合征是代谢综合征的一种.
- 肥胖医学 肥胖医学
背景情况:
- 肥胖,特别是内脏脂肪组织和中心肥胖,是心力衰竭的重要危险因素,其中包括心力衰竭的保存喷射分数 (HFpEF).
- 已建立的心力衰竭疗法可能会根据基线肥胖水平产生不同的影响.
研究的目的:
- 审查关于减肥作为治疗和预防心力衰竭 (HF) 的策略的证据.
- 检查肥胖如何影响当前HF治疗的有效性.
- 确定这一领域的知识缺口和未来的研究需求.
主要方法:
- 对当前证据的系统审查.
- 对减肥干预措施和已确定的HF治疗方法的临床试验数据的分析.
- 检查观察性研究,将肥胖,体重减轻和HF风险联系起来.
主要成果:
- 基于因克雷丁的疗法 (赛马格卢提德,提泽帕提德) 证明了对HFpEF患者的运动能力,症状和生活质量有好处.
- 患有较高肥胖症的患者可能会从基于胰岛素的疗法,矿物质皮质体受体对抗剂 (MRA),-葡萄糖运输2 (SGLT2) 抑制剂和血管激素受体-尼普利辛抑制剂 (ARNI) 中获得更大的益处.
- 观察数据表明,减肥可能会降低高血压风险,但对抗肥胖药物的随机试验尚未完成.
结论:
- 建议在肥胖和HFpEF的情况下减肥,因为提高了运动能力,功能状态和生活质量,有可能减少事件.
- 蓄意减肥对心力衰竭与减少喷射率 (HFrEF) 和初级心力衰竭预防的影响需要进一步调查.
- 大规模的心血管结局试验是必要的,以确定减肥干预措施在HF频谱中的有效性.
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