Rayner Jennifer J, Abdesselam Ines, Pan Jiliu, Lewis Andrew J M, Rider Oliver J
Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Cardiovasc Res. 2025 Jul 31;121(8):1173-1186. doi: 10.1093/cvr/cvaf090.
Obesity is one of the biggest risks to public health in both developed and developing countries, and yet incidence continues to skyrocket. Being the main risk factor for a large number of life-limiting conditions, obesity has the potential to cause enormous damage unless addressed urgently. Heart failure (HF) is the most common cardiovascular disease associated with obesity. The incidence of HF overall continues to rise and mortality rates remain high, despite the rapid and significant advances in pharmacotherapy that have recently transformed the landscape of HF treatment. Both obesity and heart failure are multisystem disorders that are closely interlinked. Obesity poses the body a number of challenges, ranging from haemodynamic, to neuroendocrine, to inflammatory, to intracellular physiology. This narrative review describes the pathophysiological 'vicious cycle' caused by the combination of obesity and HF. Management of obesity in established heart failure has for years been a controversial topic, and yet an increasing body of evidence suggests that there are numerous benefits to managing obesity and insulin resistance in heart failure. Here, we review the existing evidence base, as well as exciting new developments, suggesting that we may finally be on the brink of a revolution in managing obesity in heart failure.
肥胖是发达国家和发展中国家公共卫生面临的最大风险之一，然而其发病率仍在持续飙升。作为大量危及生命疾病的主要风险因素，肥胖若不紧急应对，有可能造成巨大损害。心力衰竭（HF）是与肥胖相关的最常见心血管疾病。尽管药物治疗最近取得了迅速而重大的进展，改变了HF治疗的格局，但HF的总体发病率仍在上升，死亡率依然居高不下。肥胖和心力衰竭都是密切相关的多系统疾病。肥胖给身体带来了诸多挑战，从血流动力学、神经内分泌、炎症到细胞内生理学等方面。这篇叙述性综述描述了由肥胖和HF共同作用导致的病理生理“恶性循环”。多年来，在已确诊心力衰竭的情况下对肥胖进行管理一直是一个有争议的话题，但越来越多的证据表明，在心力衰竭中管理肥胖和胰岛素抵抗有诸多益处。在此，我们回顾现有的证据基础以及令人振奋的新进展，这表明我们或许终于正处在心力衰竭肥胖管理变革的边缘。
