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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A variety of disciplines including noninvasive and invasive cardiac methodologies, as well as epidemiologic studies, have provided information that has altered our view on the relation of diabetes to cardiac disease. Instead of an exclusive focus on coronary artery disease, it is now recognized that heart muscle can be independently involved in diabetic patients. In diabetics without known cardiac disease, abnormalities of left ventricular mechanical function have been demonstrated in 40 to 50% of subjects, and it is primarily a diastolic phenomenon. Left ventricular hypertrophy may eventually appear in the absence of hypertension. The diastolic dysfunction appears related to interstitial collagen deposition, largely attributable to diminished degradation. The presence of even moderate obesity intensifies the abnormality. Reversibility of this process is not readily achieved with chronic insulin therapy. Experimental studies have indicated normalization of the collagen alteration by endurance training, begun relatively early in the disease process. General measures of management include the control of other cardiac risk factors and a reasonable program of physical activity. The high mortality during an initial acute myocardial infarction has been attributed to heart failure, which is managed as in nondiabetic patients. Recently, the early introduction of aspirin, thrombolysis, and beta-adrenergic blockade has reduced mortality during the initial infarction. Chronic use of the latter agent over the subsequent years has also proven to be more beneficial in diabetic patients with acute myocardial infarction compared with nondiabetic patients.
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PMID:Cardiac consequences of diabetes mellitus. 766 3

In all forms of cardiovascular disease, prevalence, incidence, morbidity and mortality are strikingly increased in obese persons, i.e. with elevated Body Mass Index or visceral adiposity. The relative excess risk for coronary events, congestive heart failure and sudden death is 1.5, 2, and 2.8 higher, respectively. Nevertheless, a paradoxical protective effect of obesity has been observed in patients with chronic heart failure, who present a better cardiovascular prognosis, i.e. lower risk of mortality, myocardial infarction, cerebrovascular events and post-PTCA bleedings. Even in patients submitted to cardiac surgery, moderate obesity is not correlated to perioperative morbidity and mortality, although sternal infections, supraventricular arrhythmias, and bleedings are more frequent. In conclusion, obese patients should undergo routine cardiac evaluation to identify those at high risk of cardiovascular events, or those with unknown coronary artery disease or asymptomatic left ventricular dysfunction. Special care should be devoted to the treatment and cardiovascular follow-up of obese patients.
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PMID:[Obesity and cardiovascular disease: expected and unexpected relationship]. 1612 63

Obesity is a known risk factor for developing cardiovascular disease, including heart failure. However, the impact of obesity on patients with heart failure is unclear. Weight reduction is a recommended method of prevention of cardiovascular disease. However, the phenomenon of the "obesity paradox" (or "reverse epidemiology") revealed that overweight and mild to moderate obesity are associated with better outcomes in patients with heart failure compared with patients at normal or ideal weight. Even more, increases of weight in cachectic heart failure patients might improve survival, although patients with heart failure who are overweight or mildly to moderately obese have better outcomes than patients with heart failure who are at ideal or normal weight. In heart failure patients, weight reduction through diet regulation, moderate exercise, and bariatric surgery can improve quality of life and New York Heart Association functional class, but it is yet unclear if these measures will improve survival.
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PMID:Impact of obesity in patients with congestive heart failure. 1989 91

Obesity is a growing public health problem in the general population, and significantly increases the risk for the development of new-onset heart failure (HF). However, in the setting of chronic HF, overweight and mild to moderate obesity is associated with substantially improved survival compared to normal-weight patients. Evidence exists for an "obesity paradox" in HF, with the majority of data measuring obesity by body mass index, but also across various less-frequently used measures of body fat (BF) and body composition including waist circumference, waist-hip ratio, skinfold estimates of percent BF, and bioelectrical impedance analysis of body composition. Other emerging areas of investigation such as the relationship of the obesity paradox to cardiorespiratory fitness are also discussed. Finally, this review explores various explanations for the obesity paradox, and summarizes the current evidence for intentional weight loss treatments for HF in context.
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PMID:Obesity and the obesity paradox in heart failure. 2443 32

In general population, cardiovascular (CV) mortality increases in parallel with obesity severity, determined by body mass index (BMI). However in cohorts of patients with coronary diseases or heart failure a decrease of the global mortality has been observed in patients aged more than 65 years old with moderate obesity (BMI = 30-35) compared to normal weight people (BMI = 20-25) and morbid obese (BMI > 35). This "obesity paradox" could result from the selection of obese people with healthy metabolic profile and way of life. BMI does not allow to distinguish lean body mass from fat mass and therefore to evaluate abdominal obesity which is associated with metabolic syndrome and CV risk.
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PMID:[The obesity paradox]. 2505 76

Obesity has reached epidemic proportions in the general population and is associated with an increased risk for the development of new-onset heart failure (HF). However, in acute and chronic HF, overweight and mild to moderate obesity is associated with substantially improved survival compared with normal weight. This phenomenon has been termed the "obesity paradox" in HF. The majority of data pertaining to the obesity paradox identifies obesity with body mass index; however, the reliability of this method has been questioned. Newer studies have explored the use of other measures of body fat and body composition, including waist circumference, waist-to-hip ratio, skinfold thickness, and bioelectrical impedance analysis of body composition. The relationship between the obesity paradox and cardiorespiratory fitness in HF is also discussed in this review, and we explore the various potential explanations for the obesity paradox and summarize the current evidence and guidelines for intentional weight loss treatments for HF in the obese population.
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PMID:Obesity and the obesity paradox in heart failure. 2566 54

Obesity continues to be a public health problem in the general population, and also significantly increases the risk for the development of new-onset heart failure (HF). However, in patients with already-established, chronic HF, overweight and mild to moderate obesity is associated with substantially improved survival compared to normal weight patients; this has been termed the "obesity paradox". The majority of studies measure obesity by body mass index, but studies utilizing less-frequently used measures of body fat and body composition, including waist circumference, waist-hip ratio, skinfold estimates, and bioelectrical impedance analysis also confirm the obesity paradox in HF. Other areas of investigation such as the relationship of the obesity paradox to cardiorespiratory fitness, gender, and race are also discussed. Finally, this review explores various explanations for the obesity paradox, and summarizes the current evidence for intentional weight loss treatments for HF in context.
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PMID:Obesity and the Obesity Paradox in Heart Failure. 2985 98