Obesity paradox in heart failure: a heavy matter

Abstract

Obesity and heart failure are two of the leading causes of morbidity and mortality in the world. The relationship between obesity and cardiovascular diseases is complex and not fully understood. While the risk of developing heart failure has been shown to be higher in patients who are obese, there is a survival advantage for obese and overweight patients compared with normal weight or low weight patients. This phenomenon was first described by Horwich et al. and was subsequently confirmed in other large trials. The advantage exists irrespective of the type, aetiology, or stage of heart failure. Patients with morbid obesity (body mass index >40 kg/m2), however, do not have the same survival advantage of their obese counterparts. There are several alternative indices of obesity available that may be more accurate than body mass index. The role of weight loss in patients with heart failure is unclear; thus, providing sound clinical advice to patients remains difficult. Future prospective trials designed to evaluate the link between obesity and heart failure will help us understand more fully this complex relationship.

Pro‐gastrin‐releasing peptide and outcome in patients with heart failure and anaemia: results from the RED‐HF study

“…Our finding that proGRP correlated strongly with galectin-3, a macrophage activation marker that is involved in the progression of HF through promotion of myocardial fibrosis and inflammation, 23,24 may suggest a role for proGRP in myocardial remodelling. 29 While BMI and proGRP were inversely correlated in our patients, no interaction between BMI and proGRP was detected. 25 Also, antagonism of the GRP receptor reduced mortality rates by limiting inflammatory infiltration in a sepsis model and attenuated TLR-4 signalling and the release of inflammatory cytokines from activated macrophages.…”

“…The inverse association between BMI and all-cause and CV deaths in our study supports the well-established inverse association between BMI and risk of mortality in HFrEF. 29 While BMI and proGRP were inversely correlated in our patients, no interaction between BMI and proGRP was detected. Finally, no association between change in proGRP levels during 6 month follow-up and outcome was observed.…”

Pulse wave velocity is decreased with obesity in an elderly Chinese population

“…The incidence of obesity in China ranks second in the world, affecting nearly one‐third of the population. Obesity remains a major risk factor for development of heart failure . However, paradoxically, overweight and other obese individuals with established disease can often have better long‐term outcome for revascularization and other therapies than do their lean counterparts .…”

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“…ischemic stroke is accompanied to poor metabolic health rather than with obesity [7]. Whether metabolomics and lysophosphatidylcholine C18:2, which associate with metabolically non-healthy obese / T2DM and may improve CV risk prediction in several populations [8].…”