Stefan D. Anker

Tipping the Scale Heart Failure, Body Mass Index, and Prognosis

Obesity has reached endemic proportions. The World Health Organization has estimated that >1 billion adults are overweight worldwide, and 300 million of them are clinically obese.1 In the general population up to 60 to 65 years of age, a higher body mass index (BMI) is associated with an increased risk for cardiovascular events and new-onset heart failure (HF). An increasing number of patients with chronic illness are obese. Of patients with chronic HF, >50% are in the overweight or obese categories.2 Although it was presumed that obesity would further increase mortality risk in patients with established HF, a number of recent studies have indicated that BMI is actually inversely associated with long-term mortality in chronic HF, the so-called obesity paradox.3 Article p 627 In this issue of Circulation , a retrospective analysis of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) trial program by Kenchaiah et al4 on the relationship between BMI and survival and other important clinical end points is reported. The authors analyzed data from all 7599 patients with symptomatic chronic HF who received candesartan (n=3803) or placebo (n=3796) and who were either angiotensin-converting enzyme inhibitor naive or already treated with such a drug. Patients were in New York Heart Association classes II through IV, and their left ventricular ejection fractions were distributed across a wide range, with a mean value of 39%. All subjects were followed up for a median of 37.7 months. Kenchaiah et al subgrouped the patients according to different BMI categories, with those with a BMI between 30.0 and 34.9 kg/m2 serving as the reference group because these patients had the overall lowest mortality. This is an important qualitative difference from most other articles on the …

РЕКОМЕНДАЦИИ ESC ПО ДИАГНОСТИКЕ И ЛЕЧЕНИЮ ОСТРОЙ И ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ 2016

2016 ESC GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC HEART FAILURE. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

Cardiac Cachexia in Chronic Heart Failure: The Metabolic Facet of CHF

Our understanding of the pathophysiology of chronic heart failure (CHF) has significantly advanced over the last 15 years from the historic haemodynamic model of mere pumping failure to a much more complex approach including multiple body systems. The concept of neuroendocrine activation is the cornerstone of the current pathophysiological understanding as well as of the therapeutic approaches that are available today. On this basis, the treatment of CHF has made significant advances over the last two decades. Moreover, treatments for acute cardiac events have improved considerably. As a consequence of effective acute and chronic therapy and a steadily growing population of the aged, a growing number of patients live for prolonged periods in a state of compensated cardiac failure. As a result not only a significant increase in prevalence numbers of CHF can be observed giving rise to the word of an epidemic proportion in the development on heart failure. Also clinical features and complications of a long-term disease progression are increasingly coming to the fore in the clinical presentation of patients. With growing understanding of the complexity of CHF pathophysiology and modern therapy starting to adopt to tailored treatment strategies of specific aspects in patients subgroups a broader and more differentiated perspective on the patients might be required with.