Complex interaction of obesity, intentional weight loss and heart failure: A systematic review and meta-analysis

Rajiv Mahajan, Michael Stokes, Adrian Elliott, Dian A. Munawar, Kashif B. Khokhar, Anand Thiyagarajah, Jeroen Hendriks, Dominik Linz, Celine Gallagher, David Kaye, Dennis Lau, Prashanthan Sanders

Research output: Contribution to journalReview article

Abstract

Objective: The aim of the meta-analysis was to determine the association of obesity and heart failure (HF) and the cardiac impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obese subjects. Methods: MEDLINE, Embase and Web of Science were searched up to 3 April 2018. Studies reporting association and prognostic impact of obesity in HF and the impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obesity were included in the meta-analysis. Results: 4959 citations were reviewed. After exclusions, 29 studies were analysed. A â J curve' relationship was observed between body mass index (BMI) and risk of HF with maximum risk in the morbidly obese (1.73 (95% CI 1.30 to 2.31), p<0.001, n=11). Although â obesity paradox' was observed for all-cause mortality, the overweight group was associated with lower cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11) with no significant differences across other BMI groups. Intentional weight loss induced by bariatric surgery in obese patients (n=9) without established HF, atrial fibrillation or known coronary artery disease, was associated with a reduction in left ventricular mass index (p<0.0001), improvement in left ventricular diastolic function (p≤0.0001) and a reduction in left atrial size (p=0.02). Conclusions: Despite the increased risk of HF with obesity, an â obesity paradox' is observed for all-cause mortality. However, the nadir for CV mortality is observed in the overweight group. Importantly, intentional weight loss was associated with improvement in indices of cardiac structure and myocardial function in obese patients. Trial registration number: APP 74412.

LanguageEnglish
JournalHeart
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • heart failure
  • obesity
  • obesity paradox
  • weight loss

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mahajan, R., Stokes, M., Elliott, A., Munawar, D. A., Khokhar, K. B., Thiyagarajah, A., ... Sanders, P. (2019). Complex interaction of obesity, intentional weight loss and heart failure: A systematic review and meta-analysis. Heart. https://doi.org/10.1136/heartjnl-2019-314770
Mahajan, Rajiv ; Stokes, Michael ; Elliott, Adrian ; Munawar, Dian A. ; Khokhar, Kashif B. ; Thiyagarajah, Anand ; Hendriks, Jeroen ; Linz, Dominik ; Gallagher, Celine ; Kaye, David ; Lau, Dennis ; Sanders, Prashanthan. / Complex interaction of obesity, intentional weight loss and heart failure : A systematic review and meta-analysis. In: Heart. 2019.
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abstract = "Objective: The aim of the meta-analysis was to determine the association of obesity and heart failure (HF) and the cardiac impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obese subjects. Methods: MEDLINE, Embase and Web of Science were searched up to 3 April 2018. Studies reporting association and prognostic impact of obesity in HF and the impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obesity were included in the meta-analysis. Results: 4959 citations were reviewed. After exclusions, 29 studies were analysed. A {\^a} J curve' relationship was observed between body mass index (BMI) and risk of HF with maximum risk in the morbidly obese (1.73 (95{\%} CI 1.30 to 2.31), p<0.001, n=11). Although {\^a} obesity paradox' was observed for all-cause mortality, the overweight group was associated with lower cardiovascular (CV) mortality (OR=0.86 (95{\%} CI 0.79 to 0.94), n=11) with no significant differences across other BMI groups. Intentional weight loss induced by bariatric surgery in obese patients (n=9) without established HF, atrial fibrillation or known coronary artery disease, was associated with a reduction in left ventricular mass index (p<0.0001), improvement in left ventricular diastolic function (p≤0.0001) and a reduction in left atrial size (p=0.02). Conclusions: Despite the increased risk of HF with obesity, an {\^a} obesity paradox' is observed for all-cause mortality. However, the nadir for CV mortality is observed in the overweight group. Importantly, intentional weight loss was associated with improvement in indices of cardiac structure and myocardial function in obese patients. Trial registration number: APP 74412.",
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Mahajan, R, Stokes, M, Elliott, A, Munawar, DA, Khokhar, KB, Thiyagarajah, A, Hendriks, J, Linz, D, Gallagher, C, Kaye, D, Lau, D & Sanders, P 2019, 'Complex interaction of obesity, intentional weight loss and heart failure: A systematic review and meta-analysis', Heart. https://doi.org/10.1136/heartjnl-2019-314770

Complex interaction of obesity, intentional weight loss and heart failure : A systematic review and meta-analysis. / Mahajan, Rajiv; Stokes, Michael; Elliott, Adrian; Munawar, Dian A.; Khokhar, Kashif B.; Thiyagarajah, Anand; Hendriks, Jeroen; Linz, Dominik; Gallagher, Celine; Kaye, David; Lau, Dennis; Sanders, Prashanthan.

In: Heart, 01.01.2019.

Research output: Contribution to journalReview article

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T1 - Complex interaction of obesity, intentional weight loss and heart failure

T2 - Heart

AU - Mahajan, Rajiv

AU - Stokes, Michael

AU - Elliott, Adrian

AU - Munawar, Dian A.

AU - Khokhar, Kashif B.

AU - Thiyagarajah, Anand

AU - Hendriks, Jeroen

AU - Linz, Dominik

AU - Gallagher, Celine

AU - Kaye, David

AU - Lau, Dennis

AU - Sanders, Prashanthan

PY - 2019/1/1

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N2 - Objective: The aim of the meta-analysis was to determine the association of obesity and heart failure (HF) and the cardiac impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obese subjects. Methods: MEDLINE, Embase and Web of Science were searched up to 3 April 2018. Studies reporting association and prognostic impact of obesity in HF and the impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obesity were included in the meta-analysis. Results: 4959 citations were reviewed. After exclusions, 29 studies were analysed. A â J curve' relationship was observed between body mass index (BMI) and risk of HF with maximum risk in the morbidly obese (1.73 (95% CI 1.30 to 2.31), p<0.001, n=11). Although â obesity paradox' was observed for all-cause mortality, the overweight group was associated with lower cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11) with no significant differences across other BMI groups. Intentional weight loss induced by bariatric surgery in obese patients (n=9) without established HF, atrial fibrillation or known coronary artery disease, was associated with a reduction in left ventricular mass index (p<0.0001), improvement in left ventricular diastolic function (p≤0.0001) and a reduction in left atrial size (p=0.02). Conclusions: Despite the increased risk of HF with obesity, an â obesity paradox' is observed for all-cause mortality. However, the nadir for CV mortality is observed in the overweight group. Importantly, intentional weight loss was associated with improvement in indices of cardiac structure and myocardial function in obese patients. Trial registration number: APP 74412.

AB - Objective: The aim of the meta-analysis was to determine the association of obesity and heart failure (HF) and the cardiac impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obese subjects. Methods: MEDLINE, Embase and Web of Science were searched up to 3 April 2018. Studies reporting association and prognostic impact of obesity in HF and the impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obesity were included in the meta-analysis. Results: 4959 citations were reviewed. After exclusions, 29 studies were analysed. A â J curve' relationship was observed between body mass index (BMI) and risk of HF with maximum risk in the morbidly obese (1.73 (95% CI 1.30 to 2.31), p<0.001, n=11). Although â obesity paradox' was observed for all-cause mortality, the overweight group was associated with lower cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11) with no significant differences across other BMI groups. Intentional weight loss induced by bariatric surgery in obese patients (n=9) without established HF, atrial fibrillation or known coronary artery disease, was associated with a reduction in left ventricular mass index (p<0.0001), improvement in left ventricular diastolic function (p≤0.0001) and a reduction in left atrial size (p=0.02). Conclusions: Despite the increased risk of HF with obesity, an â obesity paradox' is observed for all-cause mortality. However, the nadir for CV mortality is observed in the overweight group. Importantly, intentional weight loss was associated with improvement in indices of cardiac structure and myocardial function in obese patients. Trial registration number: APP 74412.

KW - heart failure

KW - obesity

KW - obesity paradox

KW - weight loss

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U2 - 10.1136/heartjnl-2019-314770

DO - 10.1136/heartjnl-2019-314770

M3 - Review article

JO - Heart

JF - Heart

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