Obesity paradox in patients with heart failure

Authors: Ján Murín 1;  Martin Wawruch 2;  Jozef Bulas 1;  František Mikla 1;  Soňa Kiňová 1
Authors place of work: I. interná klinika LF UK a UNB, Nemocnica Staré Mesto, Bratislava 1;  Ústav farmakológie a klinickej farmakológie LF UK v Bratislave 2
Published in the journal: Forum Diab 2018; 7(2): 105-107
Category: Přehledová práce


Obesity and heart failure are nowadays frequent epidemics. If a young person (about 20–25 years old) is obese, it is in greater risk to be cardiovascularly ill (heart failure included) when being ≥ 50–60 years old in comparison with another non-obese person and it will also be at risk for development of type 2 diabetes when ≥ 50 years old. Basic research is able to explain these associations. Many years ago clinicians noticed that overweight/obese persons suffering a chronic cardiovascular (heart failure included) disease have a lower morbidity / mortality in comparison with a normal weight patients. The greatest morbidity / mortality risk is in low-weight (cachectic) patients. Authors try to explain this pathophysiology of „obesity paradox“. It is a “paradox“ in healthy persons, but in patients it is „obesity paradigm“.

Key words:

cardiovascular diseases heart failure obesity obesity paradox

  1. Lavie CJ, Alpert MA, Arena R et al. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail 2013; 1(2): 93–102. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jchf.2013.01.006>.
  2. Kenchaiah S, Evans JC, Levy D et al. Obesity and the risk heart failure. N Engl J Med 2002; 347(5): 305–313. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa020245>.
  3. Alpert MA, Lambert CR, Panayioton H et al. Realtion of duration of morbid obesity to left ventricle mass, systolic function and diastolic filling, and effect of weight loss. Am J Cardiol 1995; 76(16): 1194–1197.
  4. Britton KA, Fox CS. Ectopic fat depots and cardiovascular disease. Circulation 2011; 124(24): e837-e841. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.111.077602>.
  5. Pucci G, Battista F, de Vuono S et al. Pericardial fat, insulin resistance, and left ventricular structure and function in morbid obesity. Nutr Metab Cardiovasc Dis 2014; 24(4): 440–446. Dostupné z DOI: <http://dx.doi.org/10.1016/j.numecd.2013.09.016>.
  6. Graner M, Pentikäinen MO, Nyman K et al. Cardiac steatosis in patients with dilated cardiomyopathy. Heart 2014; 100(14): 1107–1112. Dostupné z DOI: <http://dx.doi.org/10.1136/heartjnl-2013–304961>.
  7. Perrone-Filardi P, Paolillo S, Constanzo P et al. The role of metabolic syndrome in heart failure. Eur Heart J 2015; 36(39): 2630–2634. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehv350>.
  8. Barzilay JI, Krommel RA, Gottdiener JS et al. The association of fasting glucose with congestive heart failure in diabetic adults > or = 65 years: the Cardiovascular Health Study. J Am Coll Cardiol 2004; 43(12) :2236–2241. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2003.10.074>.
  9. Pocock SJ, Wang D, Pfeffer MA et al. Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J 2006; 27(1): 65–75. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehi555>.
  10. Paolillo S, Rengo G, Pellegrino T et al. Insulin resistance is associated with impaired cardiac sympathetic innervation in patients with heart failure. Eur Heart J Cardiovasc Imaging 2015; 16(10): 1148–1153. Dostupné z DOI: <http://dx.doi.org/10.1093/ehjci/jev061>.
  11. Soläng L, Malmberg K, Ryden L. Diabetes mellitus and congestive heart failure. Further knowledge needed. Eur Heart J 1999; 20(11): 789–795.
  12. Dei Cas A, Khan SS, Butler J et al. Impact of diabetes on epidemiology, treatment and outcomes of patients with heart failure. JACC Heart Fail 2015; 3(2): 136–145. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jchf.2014.08.004>.
  13. Stratmann B, Tschoepe D. Heart in diabetes: not only a macrovascular disease. Diabetes Care 2011; 34(Suppl 2): S138-S144. Dostupné z DOI: <http://dx.doi.org/10.2337/dc11-s208>.
  14. Davos Ch, Doehner W, Rauchhaus M et al. body mass and survival in patients with chronic heart failure without cachexia: the importance of obesity. J Card Fail 2003; 9(1): 29–35. Dostupné z DOI: <http://dx.doi.org/10.1054/jcaf.2003.4>.
  15. Horwich TB, Fonarow GC, Hamilton MA et al. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol 2001; 38(3): 789–795.
  16. Doehner W. Critical appraisal of the obesity paradox in cardiovascular disease: how to manage patietns with over weight in heart failure? Heart Fail Rev 2014; 19(5): 637–644. Dostupné z DOI: <http://dx.doi.org/10.1007/s10741–014–9425-z>.
  17. Doehner W, von Haehling S, Anker SD. Protective overweight in cardiovascular disease: moving from „paradox“ to „paradigm“. Eur Heart J 2015; 36(40): 2729–2732. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehv414>.
  18. Uretsky S, Messerli FH, Bangalore S et al. Obesity paradox in patients with hypertension and coronary artery disease. Am J Med 2007; 120(10): 863–870. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjmed.2007.05.011>.
  19. Khalid U, Ather S, Bavishi C et al. Pre-morbid body mass index and mortality after incident heart failure: the ARIC study. J Am Coll Cardiol 2014; 64(25): 2743–2749. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2014.09.067>.
  20. Fonarow GC, Szikanthan P, Constanzo MR et al. An obesity paradox in acute heart failure: analysis of body mass index and in hospital mortality for 108927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J 2007; 153(1): 74–81. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ahj.2006.09.007>.
  21. Shah R, Gayat E, Januzzi JL Jr et al. Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox. J Am Coll Cardiol 2014; 63(8): 778–785. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2013.09.072>.
  22. Arena R, Myers J, Abella J et al. Influence of etiology of heart failure on the obesity paradox. Am J Cardiol 2009; 104(8): 1116–1121. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjcard.2009.05.059>.
  23. Kapoor JR, Heidenreich PA. Obesity and survival in patients with heart failure nad preserved systolic function: a U-shaped relationship. Am Heart J 2010; 159(1): 75–80. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ahj.2009.10.026>.
  24. Anker SD, Ponikowski P, Varney S et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet 1997; 349(9058): 1050–1053. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(96)07015–8>. Erratum in Lancet 1997; 349(9060): 1258.
  25. Rauchhaus M, Coats AJ, Anker SD. The endotoxin – lipoprotein hypothesis. Lancet 2000; 356(9233): 930–933. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(00)02690–8>
  26. Rauchhaus M, Clark AL, Doehner W et al. The relationship between cholesterol and survival in patients with chronic heart failure. J Am Coll Cardiol 2003; 42(11): 1933–1940.
  27. Mohamed-Ali V, Goodrick S, Bulmer K et al. Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo: Am J Physiol 1999; 277(6 Pt 1): E971-E975.
  28. Kistorp C, Faber J, Galatius S et al. Plasma adiponectin, body mass index, and mortality in patients with chronic heart failure. Circulation 2005; 112(12): 1756–1762. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.104.530972>.
  29. Gupta PP, Fonarow GC, Horwich TB. Obesity and the obesity paradox in heart failure. Can J Cardiol 2015; 31(2): 195–202. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cjca.2014.08.004>.
  30. Kjekshus J, Apetrei E, Barrios V et al. Rosuvastatin in older patients with systolic heart failure. N Engl J Med 2007; 357(22): 2248–2261. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0706201>.
Diabetologie Endokrinologie Interní lékařství
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