Cardiac effects of obesity: Pathophysiologic, clinical, and prognostic consequences-A review

Journal of Cardiopulmonary Rehabilitation and Prevention

Volumn 36, Issue 1, 2016, Pages 1-11

  Alpert, Martin A ^a   Lavie, Carl J ^b   Agrawal, Harsh ^a   Kumar, Arun ^a   Kumar, Senthil A ^a  

^a University of Missouri   (United States)

^b JOHN OCHSNER HEART AND VASCULAR INSTITUTE   (United States)

Author keywords

Cardiac Rehabilitation; Cardiorespiratory Fitness; Heart Failure; Hemodynamics; Obesity; Obesity Paradox; Ventricular Function

Indexed keywords

ANGIOTENSIN RECEPTOR ANTAGONIST; CARBON DIOXIDE; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIURETIC AGENT;

ABDOMINAL OBESITY; ATRIAL FIBRILLATION; CARDIOMYOPATHY; CARDIORESPIRATORY FITNESS; CARDIOVASCULAR DISEASE; CARDIOVASCULAR MAGNETIC RESONANCE; CLINICAL FEATURE; DISEASE SEVERITY; DYSPNEA; ECHOCARDIOGRAPHY; HEART FAILURE; HEART HEMODYNAMICS; HEART INFARCTION; HEART LEFT VENTRICLE FILLING PRESSURE; HEART LEFT VENTRICLE HYPERTROPHY; HEART OUTPUT; HEART VENTRICLE FUNCTION; HUMAN; HYPERTENSION; HYPOVENTILATION; ISCHEMIC HEART DISEASE; LEFT VENTRICULAR DIASTOLIC DYSFUNCTION; OBESITY; OXYGEN CONSUMPTION; PAROXYSMAL DYSPNEA; PATHOPHYSIOLOGY; PHYSICAL ACTIVITY; PRIORITY JOURNAL; PROGNOSIS; PULMONARY ARTERY OCCLUSION PRESSURE; PULMONARY HYPERTENSION; RENIN ANGIOTENSIN ALDOSTERONE SYSTEM; REVIEW; RISK FACTOR; SLEEP DISORDERED BREATHING; SYSTEMIC VASCULAR RESISTANCE; UNDERWEIGHT; WEIGHT REDUCTION; BODY MASS; CARDIOMYOPATHIES; CLASSIFICATION; COMPLICATION; HEART VENTRICLE; HEMODYNAMICS; HYPERTROPHY, LEFT VENTRICULAR; PHYSIOLOGY; WEIGHT LOSS PROGRAM;

BODY MASS INDEX; CARDIOMYOPATHIES; HEART FAILURE; HEART VENTRICLES; HEMODYNAMICS; HUMANS; HYPERTROPHY, LEFT VENTRICULAR; OBESITY; PROGNOSIS; WEIGHT LOSS; WEIGHT REDUCTION PROGRAMS;

EID: 84952716623     PISSN: 19327501     EISSN: 1932751X     Source Type: Journal    
DOI: 10.1097/HCR.0000000000000147     Document Type: Review

References (99)

1. Alpert MA , Omran J , Mehra A , Ardhanari S . Impact of obesity and weight loss on cardiac performance and morphology in adults . Prog Cardiovasc Dis . 2014 ; 56 : 391-400 .
2. Alpert MA , Lavie CJ , Agrawal H , Aggarwal K , Kumar SA . Obesity and heart failure. Epidemiology, pathophysiology, clinical manifestations, and management . Transl Res . 2014 ; 164 : 345-356 .
3. Lavie CJ , Alpert MA , Arena R , Mehra MR , Milani RV , Ventura HO . Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure . J Am Coll Cardiol Heart Failure . 2013 ; 1 : 93-102 .
4. Abel ED , Litwin SE , Sweeney G . Cardiac remodeling in obesity . Physiol Rev . 2008 ; 88 : 389-419.
5. Wong C , Marwick TH . Obesity cardiomyopathy: pathogenesis and pathophysiology . Nature Clin Pract Cardiovasc Med . 2007 ; 4 : 436-443 .
6. Alpert MA . Obesity cardiomyopathy. Pathophysiology and evolution of the clinical syndrome . Am J Med Sci . 2001 ; 321 : 225-236 .
7. World Health Organization . Obesity: Preventing and Managing the Global Epidemic . Geneva, Switzerland : World Health Organization ; 2000 . Technical report 894.
8. Owan TE , Hodge DO , Herges RM , et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction . N Engl J Med . 2006 ; 355 : 251-259 .
9. Garg N , Senthilkumar A , Nusair MB , et al. Heart failure with a normal left ventricular ejection fraction: epidemiology, pathophysiology, diagnosis and management . Am J Med Sci . 2013 ; 346 : 129-136 .
10. Alpert MA , Terry BE , Mulekar M , et al. Cardiac morphology and left ventricular function in morbidly obese patients with and without congestive heart failure . Am J Cardiol . 1997 ; 80 : 736-740 .
11. Kenchaiah S , Evans JC , Levy D , et al. Obesity and the risk of heart failure . N Engl J Med . 2002 ; 347 : 305-313 .
12. Baena-Diez JM , Bynam AO , Grau M , et al. Obesity as an independent risk factor for heart failure: Zona Franco Cohort Study . Clin Cardiol . 2010 ; 33 : 760-764 .
13. Nicklas BJ , Lesari M , Penninx BW , et al. Abdominal obesity is an independent risk factor for heart failure in older people . J Am Geriatric Soc . 2006 ; 54 : 413-420 .
14. Lavie CJ , Ventura HO , Milani RV , Arena R . Critical impact of fitness in the prevention and treatment of heart failure . Am Heart J . 2014 ; 169 : 194-196 .
15. Alexander JK , Dennis EW , Smith WG , et al. Blood volume, cardiac output and distribution of systemic blood flow in extreme obesity . Cardiovasc Res Center Bull . 1962 ; 1 : 39-44 .
16. Alexander JK . Obesity and cardiac performance . Am J Cardiol . 1964 ; 14 : 860-865 .
17. DeDivitiis O , Fazio S , Petitto M , et al. Obesity and cardiac function . Circulation . 1981 ; 64 : 477-482 .
18. Kasper EK , Hruban RH , Baughman KL . Cardiomyopathy of obesity: a clinical pathological evaluation of 43 obese patients with heart failure . Am J Cardiol . 1992 ; 70 : 921-924 .
19. Alaud-din A , Meteressian S , Lisbona R , et al. Assessment of cardiac function in patients who were morbidly obese . Surgery . 1982 ; 92 : 226-235 .
20. Kaltman AJ , Goldring RM . Role of circulatory congestion in the cardiorespiratory failure of obesity . Am J Med . 1976 ; 60 : 645-653 .
21. Backman L , Freyschuss U , Hallberg D , Melcher A . Cardiovascular function in extreme obesity . Acta Med Scand . 1973 ; 193 : 437-446 .
22. Fazio S , Ferraro S , De Simone G , et al. Hemodynamic adaptation in severe obesity with or without arterial hypertension . Cardiologia . 1989 ; 34 : 967-972 .
23. Thakur V , Richards R , Reisin E . Obesity, hypertension and the heart . Am J Med Sci . 2001 ; 321 : 242-248 .
24. Farag NH , Matthews SC , Brzezinski E , Nelesen RA , Mills PJ . Relationship between central obesity and cardiovascular hemodynamic indices in post-menopausal women . Fertil Steril . 2004 ; 81 : 465-467 .
25. Smith HL , Willius FA . Adiposity of the heart . Arch Intern Med . 1933 ; 52 : 911-931 .
26. Amad RH , Brennan JC , Alexander JK . The cardiac pathology of obesity . Circulation . 1965 ; 32 : 740-745 .
27. Alexander JK , Pettigrove JK . Obesity and congestive heart failure . Geriatrics . 1967 ; 22 : 101-108 .
28. Warnes CA , Roberts WC . The heart in massive (more than 300 pounds or 136 kilograms) obesity. Analysis of 12 patients studies at necropsy . Am J Cardiol . 1989 ; 54 : 1087-1091 .
29. Alpert MA , Alexander JK . Cardiac morphology and obesity in man . In: Alpert MA , Alexander JK , eds. The Heart and Lung in Obesity . Armonk, NY : Futura Publishing Co ; 1998 : 25-49 .
30. Alpert MA , Terry BE , Kelly DL . Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity . Am J Cardiol . 1985 ; 55 : 783-786 .
31. Messerli FH , Sundgaard-Riise K , Reisin ED , et al. Dimorphic cardiac adaptation to obesity and arterial hypertension . Ann Intern Med . 1983 ; 94 ; 757-761 .
32. Nakajima T , Fujioka S , Tokunaga K , et al. Non-invasive study of left ventricular performance in obese patients: Influence of duration of obesity . Circulation. 1985 ; 71 : 481-485 .
33. Alpert MA , Lambert CR , Panayiotou H , et al. Relation of duration of morbid obesity to left ventricle mass, systolic function and diastolic filling, and effect of weight loss . Am J Cardiol . 1996 ; 76 : 1194-1197 .
34. Alpert MA , Lambert CR , Terry BE , et al. Effect of weight loss on left ventricular mass in non-hypertensive morbidity obese patients . Am J Cardiol . 1994 ; 73 : 918-921 .
35. Danias RG , Tritos NA , Stuber M , et al. Cardiac structure and function in the obese: a cardiac magnetic resonance imaging study . J Cardiac Res . 2003 ; 5 : 431-448 .
36. Iacobellis G , Ribaudo MC , Leto G , et al. Influence of excess fat on cardiac morphology and function and function in uncomplicated obesity . Obes Res . 2002 ; 10 : 767-773 .
37. Bella JN , Devereux RB , Roman MJ , et al. Relations of left ventricular mass to fat-free and adipose body mass: the Strong Heart Study . Circulation . 1998 ; 98 : 2538-2544 .
38. Aurigemma GP , de Simone G , Fitzgibbons TP . Cardiac remodeling in obesity . Circ Cardiovasc Imaging . 2013 ; 6 : 442-452 .
39. Woodwiss AJ , Libhaber CD , Majane OHI , et al. Obesity promotes left ventricular concentric rather than eccentric geometric remodeling and hypertrophy independent of blood pressure . Am J Hypertens . 2008 ; 21 : 1149-1153 .
40. Lauer MS , Anderson KM , Kannel WB , et al. The impact of obesity on left ventricular mass and geometry . JAMA . 1991 ; 266 : 231-236 .
41. Lavie CJ , Milani RV , Patel D , et al. Disparate effects of hypertension and obesity on left ventricular geometry and mortality in 8088 elderly patients with preserved systolic function . Postgrad Med . 2009 ; 121 : 119-125 .
42. Okpura IC , Adediran OS , Odia OJ , et al. Left ventricular geometric patterns in obese Nigerian adults: an echocardiographic study . Internet J Intern Med . 2010 ; 9 : 1-7 .
43. Peterson LR , Waggoner AD , Schectman KB , et al. Alterations in left ventricular structure and function in young healthy obese women . J Am Coll Cardiol . 2004 ; 43 : 1388-1404 .
44. Chakko S , Alpert MA . Obesity and ventricular function in man: diastolic function . In: Alpert MA , Alexander JK , eds. The Heart and Lung in Obesity . Armonk, NY : Futura Publishing Co ; 1998 : 57-76 .
45. Ferraro S , Pessone-Filardo P , Desiderio A , et al. Left ventricular systolic and diastolic function in severe obesity: a radionuclide study . Cardiology . 1996 ; 82 : 347-353 .
46. Pascual M , Pascual DA , Soria F , et al. Effects of isolated obesity on systolic and diastolic left ventricular function . Heart . 2003 ; 89 ; 1152-1156 .
47. Alpert MA , Lambert CR , Terry BE , et al. Effect of weight loss on left ventricular diastolic filling in morbid obesity . Am J Cardiol . 1997 ; 80 : 736-740 .
48. Herszkowicz N , Barbato A , Salvi W , et al. Contribution of Doppler echocardiography to the evaluation of systolic and diastolic function of obese women versus a control group . Arq Bras Cardiol . 2001 ; 76 : 189-196 .
49. Talano AC , Bitigen A , Cevik C , et al. The role of tissue Doppler study in the assessment of left ventricular dysfunction in obesity . Acta Cardiol . 2008 ; 63 : 541-546 .
50. Kossaify A , Nicolais N . Impact of overweight and obesity on left ventricular diastolic function and value of tissue Doppler echocardiography . Clin Med Insights Cardiol . 2013 ; 7 : 43-50 .
51. McGavock JM , Victor R , Unger RH , Szczepaniak LS . Adiposity of the heart revisited . Ann Intern Med . 2006 ; 144 : 515-524 .
52. Alpert MA , Alexander JK . Obesity and ventricular function in man: systolic function. In: Alpert MA, Alexander JK, eds . The Heart and Lung in Obesity . Armonk, NY : Futura Publishing Co ; 1998: 77-94 .
53. Alpert MA , Terry BE , Lambert CR , et al. Factors influencing left ventricular systolic function in non-hypertensive morbidly obese patients and effect of weight loss induced by gastroplasty . Am J Cardiol . 1993 ; 75 : 773-777 .
54. Tumuklu MM , Etikan I , Kucasik B , et al. Effect of obesity on left ventricular structure and myocardial systolic function: assessment by tissue Doppler imaging and strain/strain rate imaging . Echocardiography . 2007 ; 24 : 802-809 .
55. Orhan AL , Uslu N , Davi SU , et al. Effects of isolated obesity on left and right ventricular function: a tissue Doppler and strain rate imaging study . Echocardiography . 2010 ; 22 : 236-243 .
56. Alexander JK , Alpert MA. Pathogenesis and clinical manifestations of obesity cardiomyopathy . In: Alpert MA , Alexander JK , eds. The Heart and Lung in Obesity . Armonk NY : Futura Publishing Co ; 1998 : 133-146 .
57. Hunt SA , Abraham WT , Chin MH , et al. 2009 update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults . Circulation . 2009 ; 119 : e391 .
58. Lavie CJ , Milani RV . Effects of cardiac rehabilitation, exercise training and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics and quality of life in obese coronary patients . Am J Cardiol . 1997 ; 79 : 397-401 .
59. Lavie CJ , Milani RV . Effects of cardiac rehabilitation and exercise training on peak aerobic capacity and work efficiency in obese patients with coronary artery disease . Am J Cardiol . 1999 ; 83 : 1472-1480 .
60. Abudiab M , Aijaz B , Konecny T , et al. Usefulness of function and aerobic capacity based on stress testing to predict outcomes in normal, overweight, and obese patients . Mayo Clin Proc . 2013 ; 88 : 1427-1434 .
61. Arena R , Cahalin LP . Evaluation of cardiorespiratory fitness and respiratory muscle function in the obese population . Prog Cardiovasc Dis . 2014 ; 56 : 457-464 .
62. Oreopoulos A , Padwal RS , Kalantar-Zadeh K , Fonarow GC , Norris CM , McAlister FA . Body mass index in heart failure: a meta-analysis . Am Heart J . 2008 ; 156 : 13-22 .
63. Padwal R , McAlister FA , McMurry JJ , et al. The obesity paradox in patients with preserved is reduced ejection fraction: a metaanalysis of individual patient data . Int J Obesity . 2014 ; 38 : 1110-1114 .
64. Clark AL , Chya J , Horwich TB . The obesity paradox in men versus women with systolic heart failure . Am J Cardiol . 2012 ; 110 : 77-82 .
65. Fonarow GC , Srikanthan P , Costanzo R , et al. The obesity paradox in acute heart failure: analysis of body mass index and in-hospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry . Am Heart J . 2007 ; 153 : 74-81 .
66. Clark AL , Fonarow GC , Horwich TB . Waist circumference, body mass index and survival in systolic heart failure: the obesity paradox . J Cardiac Fail . 2011 ; 17 : 374-380 .
67. Kodama S , Saito K , Tanaka S , et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in health men and women: a meta-analysis . JAMA . 2009 ; 301 : 2024-2035 .
68. Kaminsky LA , Arena R , Beckie TM , et al. The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association . Circulation . 2013 ; 127 : 652-662 .
69. Lavie CJ , McAuley PA , Church TS , Milani RV , Blair SN . Obesity and cardiovascular diseases: implications regarding fitness, fatness and severity in the obesity paradox . J Am Coll Cardiol . 2014 ; 63 : 1345-1354 .
70. Barry VW , Baruth M , Beets MW , et al. Fitness vs fatness on allcause mortality: a meta-analysis . Prog Cardiovasc Dis . 2014 ; 56 : 382-390 .
71. Lee DC , Sui X , Artero EG , et al. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study . Circulation . 2011 ; 124 : 2483-2490 .
72. Lee DC , Sui X , Church TS , et al. Changes in fitness and fatness on development of cardiovascular disease risk factors: hypertension, metabolic syndrome, and hypercholesterolemia . J Am Coll Cardiol . 2012 ; 59 : 665-672 .
73. Clark AL , Fonarow GC , Horwich TB . Obesity and obesity paradox in heart failure . Prog Cardiovasc Dis . 2013 ; 56 : 409-414 .
74. Lavie CJ , De Schutter A , Patel D , Artham SM , Milani RV . Body composition and coronary heart disease mortality: an obesity or a lean paradox ? Mayo Clin Proc . 2011 ; 86 : 857-864 .
75. Lavie CJ , De Shutter A , Patel DA , Romero-Corral A , Artham SM , Milani RV . Body composition and survival in stable coronary heart disease: impact of lean mass index and body fat in the "obesity paradox ." J Am Coll Cardiol . 2012 ; 60 : 1374-1380 .
76. De Schutter A , Lavie CJ , Milani RV . The impact of obesity on risk factors and prevalence of coronary heart disease: the obesity paradox . Prog Cardiovasc Dis . 2014 ; 56 : 401-408 .
77. McAuley PA , Artero EG , Sui X , et al. The obesity paradox, cardiorespiratory fitness, and coronary heart disease . Mayo Clin Proc . 2012 ; 87 : 443-451 .
78. Lavie CJ , De Schutter A , Archer E , McAuley PA , Blair SN . Obesity and prognosis in chronic diseases-impact of cardiorespiratory fitness in the obesity paradox . Curr Sports Med Rep . 2014 ; 13 : 240-245 .
79. McAuley PA , Beavers KM . Contribution of cardiorespiratory fitness to the obesity paradox . Prog Cardiovasc Dis . 2014 ; 56 : 434-440 .
80. Lavie CJ . Obesity and prognosis: just one of many cardiovascular paradoxes? Prog Cardiovasc Dis. 2014 ; 56 : 367-368 .
81. Jahangir E , De Schutter A , Lavie CJ . Low weight and overweightness in older adults: risk and clinical management . Prog Cardiovasc Dis . 2014 ; 57 : 152-159 .
82. Flegal KM , Kit BK , Orpana H , Granbard BL . Association of allcause mortality with overweight and obesity using standard body mass index categories: a systematic review and metaanalysis . JAMA . 2013 ; 309 : 71-82 .
83. Lavie CJ , Cahalin LP , Chase P , et al. Impact of cardiorespiratory fitness on the obesity paradox in patients with heart failure . Mayo Clin Proc . 2013 ; 88 : 251-258 .
84. Alexander JK , Petersen KL , Cardiovascular effects of weight reduction . Circulation . 1972 ; 45 : 310-318 .
85. Backman L , Freyschuss U , Hallberg D , et al. Reversibility of cardiopulmonary changes in extreme obesity . Act Med Scand . 1979 ; 205 : 367-373 .
86. Reisin E , Frohlich ED , Messerli FH , et al. Cardiovascular changes after weight loss in obesity hypertension . Ann Intern Med . 1983 ; 98 : 315-319 .
87. Grapsa J , Tan TL , Paschou SA , et al. The effect of bariatric surgery on echocardiographic indices: a review of the literature . Eur J Clin Invest . 2013 ; 43 : 1224-1230 .
88. Jhaveri RR , Pond KK , Hauser TH , et al. Cardiac remodeling after substantial weight loss: a prospective cardiac magnetic resonance study after bariatric surgery . Surg Obes Relat Dis . 2009 ; 5 : 648-652 .
89. Luaces M , Cachofeiro V , Garcia-Munoz-Najar A , et al. Anatomical and functional alterations of the heart in morbid obesity. Changes after bariatric surgery . Rev Esp Cardiol . 2012 ; 65 : 14-21 .
90. Rider OJ , Franco JM , Ali MK , et al. Beneficial cardiovascular effects on bariatric surgical and dietary weight loss in obesity . J Am Coll Cardiol . 2009 ; 54 : 718-726 .
91. Ashrafian H , le Roux CW , Darzi A , et al. Effects of bariatric surgery on cardiovascular function . Circulation . 2008 ; 118 : 2091-2102 .
92. Estes EH , Sieker HO , McIntosh HD , et al. Reversible cardiopulmonary syndrome with extreme obesity . Circulation . 1957 ; 41 : 179-187 .
93. Miranda WR , Batsis JA , Sarr MG , et al. Impact of bariatric surgery on quality of life, functional capacity and symptoms in patients with heart failure . Obes Surg . 2013 ; 23 : 1101-1105 .
94. Swift DL , Johanasen NM , Lavie CJ , Earnest CP , Church TS . The role of exercise and physical activity in weight loss and maintenance . Prog Cardiovasc Dis . 2014 ; 56 : 441-447 .
95. Pack QR , Rodriginez-Escudero JP , Thomas RJ , et al. The prognostic significance of weight loss in coronary artery disease. A systematic review and meta-analysis . Mayo Clin Proc . 2014 ; 89 : 1368-1377 .
96. Ades PA , Savage PB . Potential benefits of weight loss in coronary heart disease . Prog Cardiovas Dis . 2014 ; 56 : 448-456 .
97. Ades PA , Savage PD , Toth MJ , et al. High-calorie-expenditure exercise. A new approach to cardiac rehabilitation for overweight coronary patients . Circulation . 2009 ; 119 : 2071-2078 .
98. Menezes AR , Lavie CJ , Milani RV , Forman DE , King M , Williams MA . Cardiac rehabilitation in the United States . Prog Cardiovasc Dis . 2014 ; 56 : 522-529 .
99. Franklin BA , Lavie CJ , Squires RW , Milani RV . Exercise-based cardiac rehabilitation and improvement in cardiorespiratory fitness: implications regarding patients benefit . Mayo Clin Proc . 2013 ; 88 : 92-97 .