Impact of Obesity on the Risk of Heart Failure and Its Prognosis

Surya M. Artham MD, Carl J. Lavie MD, Hamang M. Patel MD, Hector O. Ventura MD
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引用次数: 60

Abstract

Obesity is becoming a global epidemic in both children and adults, and it is associated with numerous comorbidities such as coronary heart disease, stroke/cerebrovascular disease, type 2 diabetes, hypertension, certain cancers, and sleep-disordered breathing. Over the past 2 decades, the incidence of and mortality from coronary heart disease and cardiovascular diseases has been continuously declining. In contrast, the incidence of and mortality from heart failure (HF) have been increasing, with HF diagnosed in approximately 5 million Americans and 550,000 new cases diagnosed each year and a death rate looming at 300,000 per year. Over the years, conventional risk factors including hypertension, type 2 diabetes, and dyslipidemia have been implicated for these unsavory statistics, and recently many studies have highlighted the important role of obesity as an independent risk factor for HF. Here, the authors review the available literature on the effects of overweight and obesity on a variety of cardiac structural adaptations and alterations, the effects on left ventricular systolic and diastolic function, and their role in the development and prognosis of HF. Numerous studies have demonstrated an “obesity paradox” regarding prognosis, however, in that obese patients with established HF tend to have a more favorable prognosis than do lean patients. Finally, the authors discuss the role of cardiopulmonary exercise testing in the risk stratification of obese patients with advanced HF.

肥胖对心力衰竭风险及其预后的影响
肥胖正在成为全球儿童和成人的流行病,它与许多合并症有关,如冠心病、中风/脑血管病、2型糖尿病、高血压、某些癌症和睡眠呼吸障碍。在过去的20年里,冠心病和心血管疾病的发病率和死亡率一直在持续下降。相比之下,心力衰竭(HF)的发病率和死亡率一直在增加,约5例患者被诊断为心力衰竭 万美国人,每年确诊55万例新病例,死亡率接近每年30万。多年来,包括高血压、2型糖尿病和血脂异常在内的传统风险因素与这些令人不快的统计数据有关,最近许多研究强调了肥胖作为HF独立风险因素的重要作用,作者回顾了关于超重和肥胖对各种心脏结构适应和改变的影响、对左心室收缩和舒张功能的影响及其在HF的发展和预后中的作用的现有文献。然而,许多研究表明,在预后方面存在“肥胖悖论”,这是因为患有已确定HF的肥胖患者往往比瘦患者具有更有利的预后。最后,作者讨论了心肺运动测试在肥胖晚期HF患者风险分层中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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