Journal of the American College of Cardiology

Does Belly Fat or High Blood Pressure More Influence Heart Failure with Normal Heart Pumping

Updated

Abstract

Central obesity is present in 80% to 90% of patients with established heart failure and preserved ejection fraction (HFpEF).

  • Changes in central obesity and visceral fat can be observed years before HFpEF is clinically evident.
  • The degree of adiposity is strongly associated with the severity of HFpEF symptoms and hemodynamics.
  • Bariatric surgery or incretin-based drugs may reduce heart failure hospitalization risk by 40% to 60% in patients with HFpEF.
  • Mendelian randomization studies indicate that obesity is more strongly linked to HFpEF than hypertension.
  • Blood pressure lowering has not consistently reduced the risk of HFpEF in patients with obesity, despite prevalent hypertension.
  • Antihypertensive drugs may not effectively alleviate heart failure symptoms if excess adiposity is not addressed.

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Funding

Competing interests

Funding Support and Author Disclosures Dr Packer has performed consulting for 89bio, Abbvie, Actavis, Altimmune, Alnylam, Amarin, Amgen, Ardelyx, ARMGO, AstraZeneca, Attralus, Biopeutics, Boehringer Ingelheim, Caladrius, Casana, CSL Behring, Cytokinetics, Daiichi-Sankyo, Imara, Lilly, Medtronic, Moderna, Novartis, Novo Nordisk, Pharmacocosmos, Regeneron, and Salamandra. Dr Butler has consulted for Abbott, American Regent, Amgen, Applied Therapeutic, AskBio, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardiac Dimension, Cardiocell, Cardior, CSL Bearing, CVRx, Cytokinetics, Daxor, Edwards, Element Science, Faraday, Foundry, G3P, Innolife, Impulse Dynamics, Imbria, Inventiva, Ionis, Levator, Lexicon, Lilly, LivaNova, Janssen, Medtronics, Merck, Occlutech, Owkin, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Prolaio, Pulnovo, Regeneron, Renibus, Roche, Salamandra, Salubris, Sanofi, SC Pharma, Secretome, Sequana, SQ Innovation, Tenex, Tricog, Ultromics, Vifor, and Zoll. Dr Lam is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Novo Nordisk and Roche Diagnostics; has served as a consultant or on the advisory board/steering committee/executive committee for Alnylam Pharma, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Biopeutics, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Corteria, CPC Clinical Research, Cytokinetics, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Janssen Research and Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, Novo Nordisk, Quidel Corporation, Radcliffe Group Ltd, Roche and Us2.ai; and serves as cofounder and non-executive director of Us2.ai. Dr Zannad has consulted for Alnylam, Bayer, Biopeutics, Boehringer, Cellprothera, Cereno, Centrix, Corteria, CVRx, CVCT, Lilly, Lupin, Merck, Novo Nordisk, Opalia Recordati, Owkin, Polygon, Ribocure, Riche, and Viatri; is on steering committees and DSMB and advisory boards for Alnylam, Bayer, Biopeutics, Boehringer, Cellprothera, Cereno, Corteria, CVRx, Merck, Owkin, Ribocure, and Roche; owns equities and stock options for Polygon, Cereno pharmaceutical, and CVCT; and is on the Speakers Bureau for Bayer, Boehringer, Centrix, CVRx, Lupin, Opalia Recordati, Merck, Novo Nordisk, and Viatris. Dr Vaduganathan has received research grant support, served on advisory boards, or had speaker engagements with Alnylam Pharmaceuticals, American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Bristol Myers Squibb, Boehringer Ingelheim, Chiesi, Cytokinetics, Esperion, Fresenius Medical Care, Idorsia Pharmaceuticals, Lexicon Pharmaceuticals, Merck, Milestone Pharmaceuticals, Novartis, Novo Nordisk, Pharmacosmos, Recordati, Relypsa, Roche Diagnostics, Sanofi, and Tricog Health; and participates on clinical trial committees for studies sponsored by Amgen, AstraZeneca, Galmed, Novartis, Bayer AG, Occlutech, Pharmacosmos, and Impulse Dynamics. Dr Borlaug receives research support from the National Institutes of Health and the U.S. Department of Defense; receives research grant funding from AstraZeneca, Axon, Corvia, Novo Nordisk, and Tenax Therapeutics; has served as a consultant for Actelion, Amgen, Aria, Axon Therapies, BD, Boehringer Ingelheim, Cytokinetics, Edwards Lifesciences, Lilly, Imbria, Janssen, Merck, Novo Nordisk, NGM, NXT, and VADovations; and is named inventor (U.S. Patent number 10,307,179) for the tools and approach for a minimally invasive pericardial modification procedure to treat heart failure.
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