Vacca Antonio, Wang Rongling, Nambiar Natasha, Capone Federico, Farrelly Catherine, Mostafa Ahmed, Sechi Leonardo A, Schiattarella Gabriele G
Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
Clinica Medica, Department of Medicine, University of Udine, Udine, Italy.
Heart Fail Rev. 2024 Sep 16. doi: 10.1007/s10741-024-10439-1.
Heart failure with preserved ejection fraction (HFpEF) is rapidly growing as the most common form of heart failure. Among HFpEF phenotypes, the cardiometabolic/obese HFpEF - HFpEF driven by cardiometabolic alterations - emerges as one of the most prevalent forms of this syndrome and the one on which recent therapeutic success have been made. Indeed, pharmacological approaches with sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have proved to be effective due to metabolic protective effects. Similarly, lifestyle changes, including diet and exercise are crucial in HFpEF management. Increasing evidence supports the important role of diet and physical activity in the pathogenesis, prognosis, and potential reversal of HFpEF. Metabolic derangements and systemic inflammation are key features of HFpEF and represent the main targets of lifestyle interventions. However, the underlying mechanisms of the beneficial effects of these interventions in HFpEF are incompletely understood. Hence, there is an unmet need of tailored lifestyle intervention modalities for patients with HFpEF. Here we present the current available evidence on lifestyle interventions in HFpEF management and therapeutics, discussing their modalities and potential mechanisms.
射血分数保留的心力衰竭（HFpEF）正迅速成为最常见的心力衰竭形式。在HFpEF表型中，心脏代谢/肥胖型HFpEF（由心脏代谢改变驱动的HFpEF）成为该综合征最普遍的形式之一，也是最近取得治疗成功的一种形式。事实上，使用2型钠-葡萄糖协同转运蛋白抑制剂（SGLT2i）和胰高血糖素样肽-1受体激动剂（GLP-1RA）的药物治疗方法已被证明因代谢保护作用而有效。同样，包括饮食和运动在内的生活方式改变在HFpEF管理中至关重要。越来越多的证据支持饮食和体育活动在HFpEF的发病机制、预后及潜在逆转中的重要作用。代谢紊乱和全身炎症是HFpEF的关键特征，也是生活方式干预的主要目标。然而，这些干预措施对HFpEF有益作用的潜在机制尚不完全清楚。因此，HFpEF患者对量身定制的生活方式干预模式存在未满足的需求。在此，我们介绍目前关于生活方式干预在HFpEF管理和治疗中的现有证据，讨论其方式和潜在机制。
