4.6 Review

The paradox of obesity cardiomyopathy and the potential for weight loss as a therapy

Journal

OBESITY REVIEWS
Volume 16, Issue 8, Pages 679-690

Publisher

WILEY
DOI: 10.1111/obr.12292

Keywords

Cardiomyopathy; heart failure; myocardial energetics; obesity paradox

Funding

  1. National Institute for Health Research [NF-SI-0512-10005] Funding Source: researchfish
  2. British Heart Foundation [FS/14/54/30946] Funding Source: Medline

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Obesity is an independent risk factor for developing heart failure and the combination of the two disease states will prove to be a significant health burden over the coming years. Obesity is likely to contribute to the development of heart failure through a variety of mechanisms, including structural and functional changes, lipotoxicity and steatosis and altered substrate selection. However, once heart failure has developed, it seems that obesity confers a beneficial influence on prognosis in what has been termed the obesity paradox'. This may be a statistical phenomenon, but it should be considered that there is truly a protective state in the physiology of obesity. There is little evidence regarding the impact of weight loss in obese heart failure and whether or not this is beneficial. There have been small studies regarding the cardiovascular effects of both dietary weight loss and bariatric surgery, but few in heart failure. This is an important and increasingly relevant clinical question which must be addressed.

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