Vest Amanda R, Schauer Philip R, Rodgers Jo E, Sanderson Emily, LaChute Courtney L, Seltz Jessica, Lavie Carl J, Mandras Stacy A, Tang W H Wilson, daSilva-deAbreu Adrian
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio, USA.
Metamor Metabolic Institute, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
JACC Heart Fail. 2024 Sep;12(9):1509-1527. doi: 10.1016/j.jchf.2024.06.006. Epub 2024 Jul 31.
Obesity is a common comorbidity among patients with heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), with the strongest pathophysiologic link of obesity being seen for HFpEF. Lifestyle measures are the cornerstone of weight loss management, but sustainability is a challenge, and there are limited efficacy data in the heart failure (HF) population. Bariatric surgery has moderate efficacy and safety data for patients with preoperative HF or left ventricular dysfunction and has been associated with reductions in HF hospitalizations and medium-term mortality. Antiobesity medications historically carried concerns for cardiovascular adverse effects, but the safety and weight loss efficacy seen in general population trials of glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide/GLP-1 agonists are highly encouraging. Although there are safety concerns regarding GLP-1 agonists in advanced HFrEF, trials of the GLP-1 agonist semaglutide for treatment of obesity have confirmed safety and efficacy in patients with HFpEF.
肥胖是射血分数降低的心力衰竭（HFrEF）或射血分数保留的心力衰竭（HFpEF）患者中常见的合并症，其中肥胖与HFpEF之间的病理生理联系最为紧密。生活方式干预是体重管理的基石，但可持续性是一项挑战，而且在心力衰竭（HF）人群中，关于其疗效的数据有限。对于术前存在HF或左心室功能障碍的患者，减肥手术具有一定的疗效和安全性数据，且与HF住院率降低及中期死亡率下降相关。从历史上看，抗肥胖药物一直存在心血管不良反应的问题，但在胰高血糖素样肽1（GLP-1）和胃抑制多肽/GLP-1激动剂的普通人群试验中观察到的安全性和减肥效果非常令人鼓舞。尽管晚期HFrEF患者使用GLP-1激动剂存在安全问题，但用于治疗肥胖的GLP-1激动剂司美格鲁肽试验已证实其在HFpEF患者中的安全性和有效性。
