Deswal Anita
Houston, TX.
Trans Am Clin Climatol Assoc. 2025;135:43-51.
Obesity is a risk factor for incident heart failure (HF), linked to, but also independent of, coexisting comorbidities. The association of obesity is stronger for HF with preserved versus reduced ejection fraction. Further, obesity is associated with a higher risk of HF hospitalization in patients with HF. However, multiple studies in patients with prevalent HF have suggested that higher body mass index (BMI) is associated with lower mortality-the "obesity survival paradox." This paradox was also observed with preexisting obesity prior to the development of HF. These observations had complicated the case for the routine recommendation of weight loss in patients with obesity and HF. However, recent trials with anti-obesity medications are leading to a better understanding of the benefits of weight loss in HF and thus support a reevaluation of the obesity survival paradox in HF.
肥胖是新发心力衰竭（HF）的一个危险因素，与并存的合并症有关，但也独立于合并症。肥胖与射血分数保留型心力衰竭的关联比与射血分数降低型心力衰竭的关联更强。此外，肥胖与心力衰竭患者因心力衰竭住院的风险较高有关。然而，多项针对已患心力衰竭患者的研究表明，较高的体重指数（BMI）与较低的死亡率相关——即“肥胖生存悖论”。在心力衰竭发生之前就已存在肥胖的情况下也观察到了这一悖论。这些观察结果使肥胖和心力衰竭患者常规建议减重的情况变得复杂。然而，近期使用抗肥胖药物的试验正在使人们更好地理解减重对心力衰竭的益处，从而支持对心力衰竭中的肥胖生存悖论进行重新评估。
