Clinical Heart and Vascular Center

Understanding the Link Between Adiposity and Heart Failure

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

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The link between obesity and heart failure has been known for decades. However, it is only recently that we have begun to understand the complex nature of this relationship. 

At the recent AHA Scientific Sessions seminar titled “Understanding the Link Between Adiposity and Heart Failure,” I discussed how the risk of heart failure increases with higher body mass index (BMI). Importantly, I presented recent data showing that elevated BMI portends a greater risk for heart failure with preserved ejection fraction (HFpEF) than for heart failure with reduced ejection fraction (HFrEF). Furthermore, BMI is a nonspecific indicator of body adiposity, and many obese individuals remain free from heart failure. Lastly, those with heart failure may actually live longer and do better when they are obese compared with normal weight (this is called "the obesity paradox"). 

“I presented recent data showing that elevated BMI portends a greater risk for heart failure with preserved ejection fraction (HFpEF) than for heart failure with reduced ejection fraction (HFrEF). Furthermore, BMI is a nonspecific indicator of body adiposity, and many obese individuals remain free from heart failure.”

Ian J. Neeland, M.D., FAHA
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Understanding the pattern of body fat can add nuanced information for management of heart failure in patients with obesity. Excess visceral fat (around the internal abdominal organs) is associated with pathological changes such as hypertrophy of the myocyte and inflammatory activation leading to heart failure. Accumulation of fat in other parts of the body where it doesn't belong (liver, pericardium, and myocardium) can also contribute to heart failure risk by secreting inflammatory hormones called adipocytokines. Simple treatments such as diet and exercise (lifestyle changes), pharmacological therapy, and bariatric surgery for weight loss can eliminate these “ectopic” fat deposits and may lower heart failure risk. Further research including randomized controlled trials is needed to test whether targeted treatment of visceral and ectopic fat can prevent and treat heart failure in the obese patient.

Read more articles from our Physician Update AHA Edition.