Adipositas und Herzinsuffizienz

Abstract

Obesity is on the on hand associated with classical risk factors for the development of chronic heart failure. On the other hand according to large scale epidemiologic trials a remarkable portion of the prevalence of chronic heart failure must be attributed to obesity alone. Explanations for the obesity associated heart failure have been given on pathophysiologic and molecular level. The central therapeutic approach to treat obesity related diseases is weight reduction. However, referring to large retrospective studies investigating the obesity paradox in chronic heart failure patients, existing overweight and obesity seem to be beneficial.

Kernaussagen

• Die Adipositas ist mit unterschiedlichen kardiovaskulären Erkrankungen und Risikofaktoren wie dem arteriellen Hypertonus, dem Diabetes mellitus, Lipidstoffwechselstörungen und der KHK, die alle auch zur Entstehung einer Herzinsuffizienz beitragen, assoziiert.

• Die Adipositas ist auch alleine – ohne dass weitere Risikofaktoren vorhanden wären – für einen relevanten Anteil der Herzinsuffizienzprävalenz verantwortlich.

• Übergewicht und Adipositas können nicht nur indirekt über die erhöhte Prävalenz von Hypertonie und KHK zur chronischen Herzinsuffizienz führen, sondern auch direkt eine metabolische Kardiomyopathie ohne Myokardischämie auslösen.

• Der wichtigste kausale Therapieansatz bei der adipositasassoziierten Herzinsuffizienz liegt in der Gewichtsreduktion. Andererseits hat die Adipositas prognostisch positive Effekte bei Patienten mit chronischer Herzinsuffizienz (Obesity Paradox).

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