Obesity is a common comorbidity among patients with heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), with the strongest pathophysiologic link of obesity being seen for HFpEF. Lifestyle measures are the cornerstone of weight loss management, but sustainability is a challenge, and there are limited efficacy data in the heart failure (HF) population. Bariatric surgery has moderate efficacy and safety data for patients with preoperative HF or left ventricular dysfunction and has been associated with reductions in HF hospitalizations and medium-term mortality. Antiobesity medications historically carried concerns for cardiovascular adverse effects, but the safety and weight loss efficacy seen in general population trials of glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide/GLP-1 agonists are highly encouraging. Although there are safety concerns regarding GLP-1 agonists in advanced HFrEF, trials of the GLP-1 agonist semaglutide for treatment of obesity have confirmed safety and efficacy in patients with HFpEF.

中文翻译：

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心力衰竭患者的肥胖和减重策略


肥胖是射血分数降低的心力衰竭 （HFrEF） 或射血分数保留的心力衰竭 （HFpEF） 患者的常见合并症，其中 HFpEF 与肥胖的病理生理学联系最强。生活方式措施是减肥管理的基石，但可持续性是一项挑战，并且在心力衰竭 （HF） 人群中的疗效数据有限。减肥手术对术前 HF 或左心室功能障碍患者具有中等疗效和安全性数据，并且与 HF 住院率和中期死亡率的减少有关。抗肥胖药物历来令人担忧心血管不良反应，但在胰高血糖素样肽 1 （GLP-1） 和胃抑制性多肽/GLP-1 激动剂的一般人群试验中观察到的安全性和减肥效果非常令人鼓舞。尽管 GLP-1 激动剂在晚期 HFrEF 中存在安全性问题，但 GLP-1 激动剂 semaglutide 治疗肥胖症的试验已证实 HFpEF 患者的安全性和有效性。