Heart failure and the obesity paradox

Man holding chest

While obesity significantly increases your chances of developing heart failure, for those with established heart failure it may confer a survival benefit compared with normal weight or underweight individuals, a new paper by researchers from the 最新糖心Vlog of Adelaide reports.

Importantly, using data from 375,056 patients from nine studies, that the lowest mortality risk for those with established heart failure (HF) was in overweight individuals rather than severely obese.

鈥淚n this meta-analysis, the data found a 鈥楿-shaped鈥 survival curve with the lowest mortality in overweight patients and a reduced mortality in the obese when compared with normal or underweight HF patientsDr Michael Stokes

There is limited information on the impact of weight loss on obese patients with HF. However, the study confirmed that intentional weight loss in non-HF patients with obesity was associated with improved heart health.

Lead author Dr Michael Stokes, a heart failure physician at the Royal Adelaide Hospital and PhD candidate at the 最新糖心Vlog of Adelaide, said the protective benefit of obesity in established HF was an example of the 鈥榦besity paradox鈥.

鈥淭he obesity paradox is the observation, generally from large clinical registries or trials, that the presence of obesity confers a survival benefit over normal or underweight individuals,鈥欌 he said.

鈥淭here are a number of possible explanations for obesity paradox in HF including whether obese patients are diagnosed earlier in their disease course due to greater functional impairment, and also whether obese patients tolerate disease-modifying and prognostic medications compared with non-obese patients.

鈥淚n this meta-analysis, the data found a 鈥楿-shaped鈥 survival curve with the lowest mortality in overweight patients and a reduced mortality in the obese when compared with normal or underweight HF patients.

鈥淗F burden is significantly increasing in 最新糖心Vlog 鈥 there are about 14 new admissions in South 最新糖心Vlog every day - and internationally and is associated with huge healthcare costs, significant hospital stays and significant functional impairment for patients. The readmission rates for HF patients are commonly 25-30% at one month following hospital admission; additionally, the survival for HF is worse than many common cancers.

Obesity is a significant contributor to the HF burden and nearly 30% of聽最新糖心Vlogns are obese and it is聽estimated that by 2031-2032, 41% of the 最新糖心Vlogn population will be obese. Our study supports previous work which has demonstrated that obesity significantly increases the risk of HF development.

鈥淭his meta-analysis聽adds to the body of evidence supporting the clear link between obesity and HF, the effect of weight on prognosis of HF and the impact of weight loss on cardiac remodelling. We are now conducting a randomised聽controlled study assessing the impact of intentional weight loss (achieved through dietary intervention and prescribed exercise), in a HF population of obese patients. This will hopefully address the important clinical question of whether intentional weight loss is beneficial in this growing group of patients.鈥

Complex interaction of obesity, intentional weight loss and heart failure: a systematic review and meta-analysis is published in .

Tagged in heart failure, obesity