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Systemic Consequences of Obesity: Its Role in Heart Failure With Preserved Ejection Fraction

In an Intention to Treat audio interview, the lead author of the semaglutide study reported previously in PNN sheds light on how cardiologists came to realize that obesity was a chief factor behind heart failure with preserved ejection fraction (HRpEF), the fastest-growing type of this difficult-to-treat and often fatal condition. The interview also includes a patient with HRpEF who lost weight and had improved function in the semaglutide trial.

“We’ve been so conditioned, as cardiologists, to kind of think, when we see a patient with heart failure, to see and think about the heart being the primary cause of the problem that it hasn’t occurred to us, as much as it should have, that in fact obesity is a systemic disease that affects multiple organ systems, and heart is just one of them,” said Mikhail Kosiborod, MD, said in discussing the STEP-HFpEF Trial. “So what happens as you gain weight is you gain fat tissue, adipose tissue, especially fat tissue around visceral organs in the bodies, like heart, kidneys, liver, and so on. The degree of inflammation goes up. And inflammation drives a number of structural changes in the heart, including fibrosis, or scar tissue formation, in the heart, which can of course make the heart more stiff and increase the degree of congestion. There is also expansion as you gain weight, especially as you gain adipose or fat tissues, there is expansion in blood volume and plasma volume, which of course can ultimately lead to congestion as well. And we know that weight gain is intricately related to a risk of worsening hypertension, or high blood pressure. And we know that high blood pressure can cause thickening of the heart muscle. But I would say this combination of inflammation increase in systemic blood pressure, or hypertension, expansion of plasma volume and blood volume ultimately leads to symptoms of congestion, which is how we define heart failure.”

Source: New England Journal of Medicine