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Review
. 2025 Oct;34(10):1033-1040.
doi: 10.1016/j.hlc.2025.08.010. Epub 2025 Sep 12.

Heart Failure With Preserved Ejection Fraction in Patients With Obesity: A Growing Cardiometabolic Concern

Andrew P Sindone  1 , Walter P Abhayaratna  2 , Alicia Chan  3 , Melissa Leung  4 , Ingrid Hopper  5 , John Amerena  6 , Carmine G De Pasquale  7 , Christine Burdeniuk  7 , Andrew J S Coats  8 , John J Atherton  9
Affiliations
Review

Heart Failure With Preserved Ejection Fraction in Patients With Obesity: A Growing Cardiometabolic Concern

Andrew P Sindone et al. Heart Lung Circ. 2025 Oct.

Abstract

Heart failure (HF) affects approximately 2.1% of adult Australians and is associated with substantial morbidity and mortality. Approximately half of all patients with HF have HF with a preserved ejection fraction (HFpEF), which is increasing in incidence driven by an ageing population and an increasing prevalence of obesity and diabetes. Obesity drives HFpEF via multiple mechanisms, with a linear relationship between various anthropometric measures and the risk of developing HFpEF. Heightened diagnostic awareness is required to identify patients with obesity-associated HFpEF, given the availability of therapeutics that have been shown to improve quality of life and clinical outcomes, including sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, and glucagon-like peptide-1 agonist-based therapies. This review provides an overview of our current understanding of the impact of obesity on the development of HFpEF and outlines an approach to diagnosis and new therapeutic options.

Keywords: Cardiovascular disease; Heart failure; Obesity.

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Conflict of interest statement

Declaration of Competing Interests The authors report the following conflicts of interest: APS: Received honoraria, speaker fees, consultancy fees, and is a member of advisory boards or has appeared on expert panels for: Abbott, Alphapharm, Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL, Edwards, Eli Lilly, Glaxo Smith Kline, Impedimed, Menarini, Merck Sharp and Dohm, Moderna, Novartis, Otsuka, Pfizer, Pharmacosmos, Roche, Sanofi, Servier, Viatris, and Vifor. WPA: Received speaker fees and/or advisory board honoraria from Amgen, Astra Zeneca, Bayer, Boehringher Ingleheim, Novartis, Novo Nordisk, and Pfizer. AC: Received research support, honoraria and/ or attended advisory boards for Astra Zeneca, Boehringer Ingelheim, CSL Seqiris, Eli Lilly, Menarini, Novartis, Roche, Novo Nordisk, and Medtronic. ML: Received honoraria, speaker fees, consultancy fees, is a member of advisory boards or has appeared on expert panels for: Amgen, Astra Zeneca, Eli Lilly, Novartis, Novo Nordisk, Pfizer, and Theramex. IH: Received honoraria, speaker fees, consultancy fees, is a member of advisory boards or has appeared on expert panels for: Astra Zeneca, Boehringer Ingelheim, CSL, Eli Lilly, Health Ed, Novartis, Novo Nordisk, and Vifor. JA: Received research support, honoraria and/ or attended advisory boards for Astra Zeneca, Bayer, Boehringer Ingelheim, CSL Seqiris, Eli Lilly, Menarini, Novartis, Novo Nordisk, Roche, and Viatris. CGDeP: Received research support, writing support and/ or attended advisory boards for AstraZeneca, Biotronic, Boehringer Ingelheim, Eli Lilly, Medtronic, Novartis, and Roche Diagnostics. CB: Received honoraria and/ or attended advisory boards for Astra Zeneca, Boehringer Ingelheim, CSL Seqiris, Eli Lilly, Johnson & Johnson, Menarini, Novartis, Roche, and Viatris. AJSC: Received research support, travel sponsorship and/ or attended advisory boards for Astra Zeneca, Bayer, Boehringer Ingelheim, Eli Lilly, GSK, Novartis, Novo Nordisk, Servier, Vifor, Actimed, Cardiac Dimensions, Corvia, ESN Cleer, Faraday, Impulse Dynamics, Respicardia, and Viatris. JJA: Received research support, travel sponsorship and/ or attended advisory boards for AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Seqirus, Eli Lilly, Merck Sharp and Dome, Novo Nordisk, Novartis, Roche Diagnostics, and Vifor Pharma. All honoraria from industry either declined or paid to his employer.