Heart failure therapy challenges in obese patients

Obesity is one of the most significant independent risk factor for developing heart failure (HF) through direct and indirect mechanisms. Excessive secretion aldosterone activation renin-angiotensin system (RAAS) in obese patients leads to sodium retention an increase extracellular volume, which contributes development increased cardiovascular risk. Abdominal visceral obesity associated not only with preserved ejection fraction (HFpEF), but also a high diabetes mellitus hypertension both sexes, more dominantly women, incidence menopause. Multiple studies meta-analyses have confirmed that regardless (HFpEF HFrEF) better survival compared those normal or underweight, phenomenon known as paradox. The HF-ACTION trial showed even small improvements cardiorespiratory fitness could lead outcomes, reducing impact paradox on clinical outcome failure. ESC recommendations advise weight loss order prevent disease overweight patients, gradual should be considered BMI > 35 kg/m2 , while BMI<35 recommended. goal bariatric procedures delay onset failure, by body factors. randomized DAPA-HF use dapagliflozin proved reduce composite worsening death BMI>30 HF BMI<30 . EMPEROR-preserved DELIVER trials therapy SGLT2 inhibitors HFpEF BMI>30kg/m2 reduces hospitalization death. It recommended terminal stage pre-transplantation period placed list transplantation achieve target values mortality after transplantation.