Challenges of heart failure pharmacotherapy in obesity

This editorial refers to ‘Implementation of guideline-directed medical therapy in patients with heart failure and obesity: European Journal of Heart Failure expert consensus document’, by L. Monzo et al., https://doi.org/10.1093/ejhf/xuag027. Overweight and obesity prevalence are on the rise. According to the World Obesity Federation, current trends suggest that by 2030, 50% of adult men and women may have high body mass index (BMI), and 17% of men and 22% of women will be living with obesity (1.13 billion people).1 The complex nature of this chronic disease and the risks of developing obesity-related comorbidities highlight the need for sustainable and effective management for individuals living with obesity.2 Specifically, obesity is highly prevalent among patients with heart failure (HF), especially those with preserved ejection fraction (HFpEF).2 Independent of obesity, systemic arterial hypoperfusion, venous congestion, and neurohormonal activation occurring in HF negatively affects the integrity and function of key organs, particularly the gastrointestinal tract, liver, and kidney. Obesity also alters haemodynamics, promotes systemic inflammation, and complicates the interpretation of biomarkers and congestion.3–5