Review articleImpact of obesity on the risk of heart failure and survival after the onset of heart failure☆
Section snippets
Evidence from community-based studies
At least five community-based prospective investigations have reported on the impact of body mass index (BMI)—an anthropometric index of overall excess fat, calculated as the weight in kilograms divided by the square of the height in meters—on the risk of HF (Table 1) [5], [6], [7], [8], [9]. These studies included middle-aged [7], [8], [9] and elderly [5], [6] free-living individuals who were predominantly white; over a half were women (with the exception of the Swedish study conducted
Impact of overweight and obesity on survival after the onset of heart failure
After the onset of HF, BMI is influenced by several factors. Fluid overload, a feature of overt HF, may increase BMI. Excessive diuresis, an inadvertent adverse effect of the medical management of HF, may reduce BMI. Cardiac cachexia, caused by such reasons as increased resting metabolic rate, anorexia, malabsorption, and cytokine activation [87], [88], may be an underlying factor for a major weight loss. Older age, a poor prognostic indicator among HF patients [89], is associated with
Clinical implications
There is consistent evidence from published studies that overweight and obesity increases the future risk of HF. Although there are no studies evaluating the impact of changes in weight on the incidence of HF, weight reduction to optimal levels in overweight and obese children and adults and maintenance of body weight at optimal levels should be promoted.
Notwithstanding the limitations of published studies evaluating the prognostic significance of BMI in patients with HF, it is clear that
Future directions for research
Suggested directions for future epidemiologic investigations are displayed in Box 1
Summary
Obesity is related to HF in a complex fashion. Whereas obesity is a risk factor for HF, elevated BMI seems to favorably influence survival after the onset of HF (obesity paradox) [114]. Additional carefully performed investigations are warranted to provide further insights into how elevated BMI influences HF risk and prognosis. Studies of larger multiethnic cohorts and mechanistic investigations may advance knowledge regarding the impact of obesity on HF.
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This work was supported in part through National Institute of Health/National Heart, Lung, and Blood Institute Contract N01-HC-25195. Dr. Vasan is the recipient of a research career award 2K24 HL04334 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.