title: [Obesity and heart failure].
abstract: BACKGROUND
  Obesity is an important risk factor for the development of heart failure.
  
  
  METHODS
  In normotensive obese patients, a reduced peripheral resistance is typically observed and is accompanied by an increased fluid volume and an increase in cardiac work, resulting in hypertrophy and diastolic heart failure, which can be visualized with echocardiography. However, in the presence of arterial hypertension cardiac geometry is not different to hypertensive heart disease without obesity. Furthermore, the typical changes found with obesity, such as reduced peripheral resistance and increased blood volume, are no longer present. Obstructive sleep apnea (OSA) is very common in obesity and warrants screening but levels of the heart failure marker N-terminal pro-brain natriuretic peptide (NT-ProBNP) might be misleading as the values are lower in obesity than in normal weight controls.
  
  
  METHODS
  Body weight reduction is advisable but difficult to achieve and much more difficult to maintain. Furthermore, diet and exercise has not been proven to enhance life expectancy in obesity. However, with bariatric surgery, long-term weight reduction can be achieved and mortality can be reduced.
  
  
  CONCLUSIONS
  With effective weight loss and improved clinical outcome after bariatric surgery, treatment of obesity has shifted much more into focus. Regardless of technical challenges in the work-up of obese patients, clinical symptoms suggestive of cardiac disorders warrant prompt investigation with standard techniques following recommendations as established for normal weight patients.
authors: Schwerpunkt Endokrinologie und Diabetologie, Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland, weismann_d@klinik.uni-wuerzburg.de.
authors: D
authors: D
authors: Weismann
authors: S
authors: S
authors: Wiedmann
authors: M
authors: M
authors: Bala
authors: S
authors: S
authors: Frantz
authors: M
authors: M
authors: Fassnacht
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D004035:Diet Therapy / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
references: J Am Coll Cardiol. 2013 Aug 20;62(8):685-91
references: 23948512
references: Circulation. 2004 Dec 14;110(24):3674-9
references: 15569841
references: Int J Cardiol. 2014 Oct 20;176(3):611-7
references: 25156856
references: Internist (Berl). 2008 Apr;49(4):389-90, 392-3
references: 18322666
references: JAMA. 2013 Jan 2;309(1):71-82
references: 23280227
references: JACC Heart Fail. 2013 Apr;1(2):93-102
references: 24621833
references: Obesity (Silver Spring). 2011 Nov;19(11):2268-73
references: 21720437
references: Clin Cardiol. 2008 Nov;31(11):516-20
references: 19006115
references: Am Heart J. 2014 Sep;168(3):280-288.e2
references: 25173538
references: Ann Surg. 2000 Oct;232(4):515-29
references: 10998650
references: Transl Res. 2014 Oct;164(4):345-56
references: 24814682
references: Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):391-400
references: 24438730
references: Clin Chem. 2006 Apr;52(4):680-5
references: 16497939
references: Eur Heart J. 2005 Jan;26(1):5-7
references: 15615792
references: JAMA Neurol. 2014 Aug;71(8):978-84
references: 24886975
references: Epidemiology. 2014 Jan;25(1):10-4
references: 24270963
references: Obes Facts. 2014;7(1):57-68
references: 24525549
references: Heart Fail Rev. 2013 Mar;18(2):207-17
references: 22610359
references: Lancet. 2008 May 24;371(9626):1783-9
references: 18502303
references: Nat Clin Pract Cardiovasc Med. 2007 Sep;4(9):480-90
references: 17712361
references: J Nucl Cardiol. 2006 Mar-Apr;13(2):202-9
references: 16580956
references: Nature. 2013 Nov 28;503(7477):493-9
references: 24172895
references: N Engl J Med. 2002 Aug 1;347(5):305-13
references: 12151467
references: J Intern Med. 2002 Jul;252(1):70-8
references: 12074741
references: J Am Coll Cardiol. 2014 Mar 25;63(11):1071-8
references: 24345592
references: J Cardiovasc Comput Tomogr. 2009 Jan-Feb;3(1):35-42
references: 19136325
references: J Am Coll Cardiol. 2011 Oct 25;58(18):1870-7
references: 22018297
references: Catheter Cardiovasc Interv. 2002 Jun;56(2):174-7
references: 12112908
references: N Engl J Med. 2006 Jul 20;355(3):251-9
references: 16855265
references: Echocardiography. 2013 Sep;30(8):904-11
references: 23496241
references: J Hypertens. 2012 Dec;30(12):2271-5
references: 23151882