Obesity and Heart Failure

Electrocardiogram (ECG EKG) with human heart on screen
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Obesity is a risk factor for cardiovascular disease, including heart failure. There are currently over five million American adults who are living with heart failure, and by 2030, that number is expected to exceed eight million.

What Is Heart Failure?

Simply put, there are two main kinds of heart failure: systolic heart failure and diastolic heart failure. In systolic heart failure, the heart fails to pump normally; this is associated with a reduced ejection fraction (a measure of pump function).

In diastolic heart failure, more recently known as heart failure with preserved ejection fraction, the ejection fraction is normal, but the heart is still not pumping normally due to the heart muscle being very stiff.

Both systolic and diastolic heart failure have a variety of causes, and even share some causes, such as high blood pressure, coronary artery disease, and obesity.

Either kind of heart failure can lead to the symptoms of what is known as congestive heart failure, in which fluid accumulates in the lungs, making it difficult to breathe; fluid can also accumulate in the legs, causing swelling and discomfort.

Obesity and Heart Failure

In addition to causing other diseases that can lead to heart failure such as diabetes, high blood pressure, and coronary artery disease, obesity in itself is a risk factor for heart failure.

In the latest guideline on heart failure released in 2013 by the American College of Cardiology Foundation and the American Heart Association, obesity is considered to be a starting point for heart failure.

This guideline lists obesity as a medical condition that would, by itself, place a patient in Stage A of heart failure. Stage A, as defined by this national guideline, encompasses all patients who are “at high risk for heart failure but without structural heart disease or symptoms of heart failure.”

Therefore, obesity alone categorizes a patient as having Stage A heart failure. A patient with obesity who had symptoms of heart failure or signs of structural heart disease would be categorized into a later stage (B through D) of heart failure.

As has been noted elsewhere, obesity increases inflammation within the body, and inflammation has been found to play a major role in atherosclerosis and coronary artery disease. Obesity thus can affect all aspects of the cardiovascular system.

Sources

Go AS, Mozaffarian D, Roger VL, et al. Executive summary: heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation 2014;129:339-410.

Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 2013;6:606-19.

Juonala M, Magnussen CG, Berenson GS, Venn A, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011; 365:1876-1885.

Yancy CW, Jessup M. Bozkurt B, Butler J, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013 Jun 5 [Epub ahead of print].

Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352:1685-1695.

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