Obesity and diabetes double heart failure risk

LONDON - Obesity and type-2 diabetes double the risk of heart failure, already the world’s most prevalent chronic cardiovascular disease.

John McMurray, professor of cardiology at Western Infirmary, said that a third of patients with heart failure have evidence of diabetes, for whom effective treatment is “very difficult”.

The latest report from Euroaspire, Europe’s largest survey of cardiovascular risk factors in coronary patients, found the prevalence of obesity had increased from 25 percent in 1997 to 38 percent in just 10 years. These were people who had already had at least one heart attack.

Cardiologists emphasised that obesity is not just associated with an increased risk of heart attack, but also with an increased risk of heart failure.

“Obesity is at least as great a risk factor for heart failure as it is for heart attack or stroke,” said McMurray. “Obesity more than doubles the risk.”

The pathways by which obesity plays such a role in heart failure are not yet fully understood, but have been shown to have an indirect effect via hypertension, or heart attack, or diabetes and a direct effect on the heart muscle itself.

“We know that the underlying changes in the structure and function of the heart may be different in obese and non-obese patients with heart failure,” said McMurray.

Heart failure patients with diabetes also have worse symptoms, a higher risk of hospitalisation and a greater risk of death than those without diabetes - suggesting that the underlying pathophysiology of heart failure may be different in diabetics and non-diabetics.

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