Heart failure and obesity: Translational approaches and therapeutic perspectives. A scientific statement of the Heart Failure Association of the ESC

Abstract

Obesity and heart failure (HF) represent two growing pandemics. In the general population, obesity affects one in eight adults and is linked with an increased risk for HF. Obesity is even more common in patients with HF, where it complicates the diagnosis of HF and is linked with worse symptoms and impaired exercise capacity. Over the past few years, new evidence on the mechanisms linking obesity with HF has been reported, particularly in relation to HF with preserved ejection fraction. Novel therapies inducing weight loss appear to have favourable effects on health status and cardiovascular risk. Against the backdrop of this rapidly evolving evidence landscape, HF clinicians are increasingly required to tailor their preventive, diagnostic, and therapeutic approaches to HF in the presence of obesity. This scientific statement by the Heart Failure Association of the European Society of Cardiology provides an up-to-date summary on obesity in HF, covering key areas such as epidemiology, translational aspects, diagnostic challenges, therapeutic approaches, and trial design.

Keywords: HFpEF; HFrEF; Heart failure; Obesity; Risk factors.

Figure 1

Obesity prevalence in the overall population, and risk of and complications in heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF). QoL, quality of life.

Figure 2

Pathophysiological link between obesity and heart failure (HF). LV, left ventricle; RAAS, renin–angiotensin–aldosterone system; RV, right ventricle; SNS, sympathetic nervous system.

Figure 3

Obesity and molecular effects on the cardiomyocyte. HF, heart failure; LCFA, long‐chain fatty acid; SCFA, short‐chain fatty acid.