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Review
. 2024 Sep;12(9):1509-1527.
doi: 10.1016/j.jchf.2024.06.006. Epub 2024 Jul 31.

Obesity and Weight Loss Strategies for Patients With Heart Failure

Amanda R Vest  1 , Philip R Schauer  2 , Jo E Rodgers  3 , Emily Sanderson  4 , Courtney L LaChute  5 , Jessica Seltz  6 , Carl J Lavie  7 , Stacy A Mandras  8 , W H Wilson Tang  1 , Adrian daSilva-deAbreu  9
Affiliations
Free article
Review

Obesity and Weight Loss Strategies for Patients With Heart Failure

Amanda R Vest et al. JACC Heart Fail. 2024 Sep.
Free article

Abstract

Obesity is a common comorbidity among patients with heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), with the strongest pathophysiologic link of obesity being seen for HFpEF. Lifestyle measures are the cornerstone of weight loss management, but sustainability is a challenge, and there are limited efficacy data in the heart failure (HF) population. Bariatric surgery has moderate efficacy and safety data for patients with preoperative HF or left ventricular dysfunction and has been associated with reductions in HF hospitalizations and medium-term mortality. Antiobesity medications historically carried concerns for cardiovascular adverse effects, but the safety and weight loss efficacy seen in general population trials of glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide/GLP-1 agonists are highly encouraging. Although there are safety concerns regarding GLP-1 agonists in advanced HFrEF, trials of the GLP-1 agonist semaglutide for treatment of obesity have confirmed safety and efficacy in patients with HFpEF.

Keywords: bariatric surgery; heart failure; lifestyle; metabolism; nutrition; obesity; physical activity; weight loss.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Schauer has consultancy agreements with GI Dynamics; Keyron; Persona; Mediflix, Metabolic Health International, Lilly, Ethicon, Medtronic, Novo Nordisk, and Heron; ownership interest in SE Healthcare, Mediflix, and Metabolic Health International; and has received research funding from Ethicon and Medtronic. Dr Lavie has been a speaker and consultant for AstraZeneca on an SGLT2i; and has served on a data and safety monitoring board for Novo Nordisk. Dr Mandras has been a consultant and has served on the Speakers Bureaus for Bayer, CVRX, and United Therapeutics. Dr Tang has served as a consultant for Sequana Medical, Cardiol Therapeutics, Genomics, Zehna Therapeutics, Renovacor, WhiteSwell, Kiniksa Pharmaceuticals, Boston Scientific, CardiaTec Biosciences, and Intellia; and has received honoraria from Springer Nature and American Board of Internal Medicine. Dr daSilva-deAbreu owns stocks of TransMedics Group. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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