Treatment options for heart failure in individuals with overweight or obesity: a review.

Djordje S Popovic, Efstratios Karagiannidis, Paschalis Karakasis, Panagiotis Stachteas, Aleksandra Klisic, Dimitrios Patoulias, Nikolaos Fragakis, Theocharis Koufakis, Athina Nasoufidou, Christos Kofos

Journal: Future cardiology 2025;21(5):315-329

PMID: 40098467

Abstract

Obesity and heart failure are interlaced global epidemics, each contributing to significant morbidity and mortality. Obesity is not only a risk-factor for heart failure, but also complicates its management, by distinctive pathophysiological mechanisms and cumulative comorbidities, requiring tailored treatment plan. To present current treatment options for heart failure in individuals with overweight/obesity, emphasizing available pharmacological therapies, non-pharmacological strategies, and the management of related comorbidities. We conducted a comprehensive literature review regarding the results of heart failure treatments in individuals with overweight/obesity, including cornerstone interventions as well as emerging therapeutic options. Specific drug classes, including angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, have demonstrated consistent efficacy in heart failure irrespective of body mass index, while diuretics remain a key for fluid management. Glucagon-like peptide-1 receptor agonists have shown promising results in improving relevant outcomes and warrant further research. Non-pharmacological approaches, including weight-loss strategies and lifestyle modifications, have shown to improve symptoms, exercise tolerance and quality of life. Managing heart failure in individuals with overweight/obesity requires a multidisciplinary, individualized approach integrating pharmacological and non-pharmacological options. Emerging therapies and preventive strategies arise to address the unique challenges in this population and provide improved outcomes.

Address: Second Department of Cardiology, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.; Hippokration General Hospital of Thessaloniki, Thessaloniki Greece.; Department of Emergency Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.; AHEPA University Hospital, Thessaloniki, Greece.; Faculty of Medicine, University of Montenegro, Podgorica, Montenegro.; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia.; Hippokration General Hospital of Thessaloniki, Thessaloniki Greece.; Second Propedeutic Department of Internal Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece.; Second Department of Cardiology, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.

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