Is Heart Failure with Preserved Ejection Fraction an Obesity Disease?

By Ian J. Neeland, M.D., FAHA
Assistant Professor of Internal Medicine

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome defined by the presence of three cardi­nal features: 1) signs and symptoms consistent with heart failure; 2) absence of a depressed left ventricular ejection fraction; and 3) objective measures showing impaired left ventricular diastolic function. Approximately 50 percent of all heart failure patients meet criteria for HFpEF.

There are many risk factors for HFpEF, including coronary artery disease, hyperten­sion, diabetes mellitus, and obesity. Among risk factors, only obesity has been steadily increasing in prevalence over the past decade, and projec­tions forecast that 50 percent of Americans will be obese by the year 2030. Studies show that obesity portends higher risk for HFpEF than for heart failure with reduced ejection fraction (HFrEF). In fact, an individual with obesity has a greater than 30 percent higher risk for HFpEF compared with a similar yet non-obese person.

The good news is that intentional weight loss appears to mitigate the effects of obesity on risk for and symptoms of HFpEF. In one study, obese participants in a combined program of ex­ercise and diet improved their cardiorespiratory fitness by about 1 percent for each 1 percent of body weight lost. Furthermore, many studies show that surgical weight loss can improve cardiac structure and function and alleviate symptoms in HFpEF patients. 

The message is clear: Intentional weight loss is achievable with lifestyle intervention and surgical therapies in those with obesity and HFpEF. Even modest weight loss can improve symptoms, quality of life, and exercise capacity in obese patients with HFpEF, so cardiologists should continue to counsel patients on main­taining a healthy body weight to prevent and treat the growing epidemic of HFpEF.