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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2014; 08(02): 76-80
DOI: 10.1055/s-0037-1618843
Übersichtsarbeit
Schattauer GmbH

Herzinsuffizienz bei Adipositas und Metabolischem Syndrom

Heart insufficiency in obesity and metabolic syndrome
A. Baessler
1   Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg
,
M. Fischer
1   Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg
› Author Affiliations
Further Information

Publication History

Publication Date:
21 December 2017 (online)

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Zusammenfassung

Das Risiko für die Entwicklung der Herzinsuffizienz wird durch Adipositas verdoppelt. Dabei führt die Adipositas nicht nur indirekt über die Zunahme von kardiovaskulären Risikofaktoren und koronarer Herzkrankheit zu chronischer Herzinsuffizienz, sondern auch direkt über die veränderten hämodynamischen, metabolischen und neurohumoralen Eigenschaften. Zur Prävention der Herzinsuffizienz, z.B. bei Zeichen einer beginnenden diastolischen Dysfunktion oder bei metabolischen Alterationen, erscheint die Gewichtsreduktion als kausale Therapie sinnvoll.

Sowohl Gewichtsreduktion als auch körperliches Training sind prinzipiell in der Lage, durch günstige Effekte auf kardiovaskuläre Risikofaktoren die frühe Adipositas-assoziierte Herzinsuffizienz zu verbessern. Jedoch kann die hierfür notwendige dauerhafte Lebensstilintervention von den Betroffenen häufig nicht erfolgreich umgesetzt werden. Im Gegensatz dazu sind die prognostischen Effekte der Gewichtsreduktion bei bereits manifester Herzinsuffizienz aufgrund des Adipositas-Paradoxons noch umstritten. Die Durchführung gezielter prospektiver Therapiestudien zum besseren Verständnis der Interaktionen zwischen Adipositas, Gewichtsreduktion und Herzinsuffizienz ist anzustreben.

Summary

Obesity doubles the risk of heart failure. Obesity promotes alterations in cardiovascular risk factors that indirectly promote the development of heart failure, but a variety of hemodynamic, metabolic, and neurohumoral adaptations in cardiovascular structure and function also contribute directly to decreased cardiac function. Therapeutic approaches to prevent heart failure include weight control by dietary intervention and increased physical activity, particularly when there is evidence of left ventricular diastolic dysfunction and/or metabolic alterations. Several studies have provided convincing data on the benefits of weight reduction and physical activity on cardiovascular risk associated with obesity. However, the proportion of patients that benefit from the lifestyle interventions is limited by the difficulty in maintaining weight loss and exercising on a regular basis. In contrast, the prognostic effects of weight reduction in obese patients with overt heart failure are debatable as these patients paradoxically seem to have a more favourable clinical prognosis. Further prospective studies and new approaches are needed to elucidate the mechanisms for the relationship between obesity, weight reduction modalities and heart failure prognosis.

Schlüsselwörter

Adipositas - Metabolisches Syndrom - Herzinsuffizienz - diastolische Dysfunktion - Gewichtsreduktion

Keywords

Obesity - metabolic syndrome - heart failure - diastolic dysfunction - weight reduction
 

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