The Hemodynamic Obesity Paradox: Decoupling of Hemodynamics and Congestive Symptoms in Patients with Heart Failure and Obesity.

Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, has become increasingly prevalent, affecting 4 of 10 adults in the United States. 1 Carbone S Lavie CJ Elagizi A Arena R Ventura HO. The impact of obesity in heart failure. Heart Fail Clin. 2020; 16: 71-80https://doi.org/10.1016/j.hfc.2019.08.008 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar The impact of obesity on heart failure (HF) risk and disease development continues to be an area of ongoing research. Prior studies have demonstrated the strongest dose/response relationship between BMI and incident HF for HF with preserved ejection fraction (HFpEF) compared to HF with reduced ejection fraction (HFrEF). 2 Mahajan R Stokes M Elliott A Munawar DA Khokhar KB Thiyagarajah A et al. Complex interaction of obesity, intentional weight loss and heart failure: a systematic review and meta-analysis. Heart. 2020; 106: 58-68https://doi.org/10.1136/heartjnl-2019-314770 Crossref PubMed Scopus (57) Google Scholar Obesity is not merely a comorbidity; it contributes directly to the pathogenesis of HF via multiple mechanisms, as explained in Fig. 1. 1 Carbone S Lavie CJ Elagizi A Arena R Ventura HO. The impact of obesity in heart failure. Heart Fail Clin. 2020; 16: 71-80https://doi.org/10.1016/j.hfc.2019.08.008 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar In addition, obesity accelerates early atherosclerotic changes and is associated with many cardiovascular risks factors, including elevated blood pressure, dyslipidemia and hyperglycemia; each can impact the pathogenesis of HF. 3 Powell-Wiley TM Poirier P Burke LE Després JP Gordon-Larsen P Lavie CJ et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021; 143: e984-1010https://doi.org/10.1161/cir.0000000000000973 Crossref PubMed Scopus (0) Google Scholar Decoupling of Hemodynamics and Congestive Symptoms in Obese Patients With Heart FailureJournal of Cardiac FailureVol. 29Issue 9PreviewThe prevalence of obesity in the United States has increased significantly in recent decades.1,2 Obesity is a potent risk factor for the development of heart failure (HF).3–5 As the obesity epidemic spreads, it will be increasingly important to understand the hemodynamic effects of obesity in both acute and chronic HF states. Full-Text PDF