Skip to main content
SpringerLink
Log in

Metabolic Syndrome and Heart Failure—The Risk, Paradox, and Treatment

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

The constellation of obesity, hypertension, dyslipidemia, and insulin resistance—together referred to as metabolic syndrome (MetS)—is increasing in prevalence in the American population and also worldwide. The individual components of MetS and MetS as a whole increase the risk of heart failure, cardiovascular mortality, and all-cause mortality. Despite this adverse association, numerous studies have documented an obesity paradox, in which overweight and obese people with established cardiovascular disease, including hypertension, coronary heart disease, heart failure, and peripheral arterial disease, have a better prognosis than patients who are not overweight or obese. Current treatment strategies for these patients include weight loss, control of blood pressure and cholesterol levels, and treatment of hyperglycemia. Because of increasing evidence for the obesity paradox, some physicians question whether obesity should be treated when it is associated with heart failure. Several studies have shown improvement in left ventricular function and decreased mortality and morbidity from heart failure with weight loss and treatment of elevated blood pressure, cholesterol, and hyperglycemia. The most reasonable approach at this time appears to be weight loss and exercise, lowering blood pressure to less than 130/80 mm Hg, low-density lipoprotein (LDL) cholesterol to less than 100 mg/dL, and glycosylated hemoglobin levels to less than 7%.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. He J, Ogden LG, Bazzano LA, et al.: Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 2001, 161:996–1002.

    Article  PubMed  CAS  Google Scholar 

  2. Kenchaiah S, Evans JC, Levy D, et al.: Obesity and the risk of heart failure. N Engl J Med 2002, 347:305–313.

    Article  PubMed  Google Scholar 

  3. Iribarren C, Karter AJ, Go AS, et al.: Glycemic control and heart failure among adult patients with diabetes. Circulation 2001, 103:2668–2673.

    PubMed  CAS  Google Scholar 

  4. Lakka HM, Laaksonen DE, Lakka TA, et al.: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002, 288:2709–2716.

    Article  PubMed  Google Scholar 

  5. Sattar N, Gaw A, Scherbakova O, et al.: Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003, 108:414–419.

    Article  PubMed  CAS  Google Scholar 

  6. Malik S, Wong ND, Franklin SS, et al.: Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004, 110:1245–1250.

    Article  PubMed  Google Scholar 

  7. Arnlov J, Ingelsson E, Sundstrom J, Lind L: Impact of body mass index and metabolic syndrome on the risk of cardiovascular disease and death in middle-aged me. Circulation 2010, 121:230–236.

    Article  PubMed  Google Scholar 

  8. Levy D, Kenchaiah S, Larson MG, et al.: Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002, 347:1397–1402.

    Article  PubMed  Google Scholar 

  9. Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15:539–553.

    Article  PubMed  CAS  Google Scholar 

  10. Expert panel on detection, evaluation and treatment of high blood cholesterol in adults: Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497.

    Google Scholar 

  11. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002, 287:356–359.

    Article  PubMed  Google Scholar 

  12. Ingelsson E, Arnlöv J, Lind L, Sundström J: Metabolic syndrome and risk for heart failure in middle-aged men. Heart 2006, 92:1409–1413.

    Article  PubMed  CAS  Google Scholar 

  13. • Bahrami H, Bluemke DA, Kronmal R, et al.: Novel metabolic risk factors for incident heart failure and their relationship with obesity. J Am Coll Cardiol 2008, 51:1775–1783. A community-based multicenter cohort study showing associations between HF and the metabolic syndrome, inflammatory markers, insulin resistance, and albuminuria.

    Article  PubMed  CAS  Google Scholar 

  14. Krauss RM, Winston M, Fletcher BJ, Grundy SM: Obesity: Impact on cardiovascular disease. Circulation 1998, 98:1472–1476.

    CAS  Google Scholar 

  15. Litwin SE: Which measures of obesity best predict cardiovascular risk? J Am Coll Cardiol 2008, 52:616–619.

    Article  PubMed  Google Scholar 

  16. •• Hu G, Jousilahti P, Antikainen R, et al.: Joint effects of physical activity, body mass index, waist circumference, and waist-to-hip ratio on the risk of heart failure. Circulation 2010, 121:237–244. An excellent study showing that overweight and obesity in general increase the risk of HF, and moderate or high levels of physical activity are associated with a reduced risk of HF.

    Article  PubMed  Google Scholar 

  17. Alpert MA, Terry BE, Mulekar M, et al.: Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. Am J Cardiol 1997, 80:736–740.

    Article  PubMed  CAS  Google Scholar 

  18. Poirier P, Giles TD, Bray GA, et al.; American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism: Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity and Metabolism. Circulation 2006, 113:898–918.

    Article  PubMed  Google Scholar 

  19. Alpert MA: Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001, 321:225–236.

    Article  PubMed  CAS  Google Scholar 

  20. Martin SS, Qasim A, Reilly MP: Leptin resistance: a possible interface of inflammation and metabolism in obesity-related cardiovascular disease. J Am Coll Cardiol 2008, 52:1201–1210.

    Article  PubMed  CAS  Google Scholar 

  21. de Divitis O, Fazio S, Petitto M, et al.: Obesity and cardiac function. Circulation 1981, 64:477–481.

    Google Scholar 

  22. Wildman RP, Mackey RH, Bostom A, et al.: Measures of obesity are associated with vascular stiffness in young and older adults. Hypertension 2003, 42:468–473.

    Article  PubMed  CAS  Google Scholar 

  23. Lavie CJ, Amodeo C, Ventura HO, Messerli FH: Left atrial abnormalities indicating diastolic ventricular dysfunction in cardiomyopathy of obesity. Chest 1987, 92:1042–1046.

    Article  PubMed  CAS  Google Scholar 

  24. Alpert MA, Lambert CR, Panayiotou H, et al.: Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. Am J Cardiol 1995, 76:1194–1197.

    Article  PubMed  CAS  Google Scholar 

  25. Lavie CJ, Milani RV, Ventura HO, et al.: Disparate effects of left ventricular geometry and obesity on mortality in patients with preserved left ventricular ejection fraction. Am J Cardiol 2007, 100:1460–1464.

    Article  PubMed  Google Scholar 

  26. Epstein LJ, Kristo D, Strollo PJ Jr, et al.: Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009, 5:263–276.

    PubMed  Google Scholar 

  27. Horwich TB, Fonarow GC, Hamilton MA, et al.: The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol 2001, 38:789–795.

    Article  PubMed  CAS  Google Scholar 

  28. Lavie CJ, Osman AF, Milani RV, Mehra MR: Body composition and prognosis in chronic systolic heart failure: the obesity paradox. Am J Cardiol 2003, 91:891–894.

    Article  PubMed  Google Scholar 

  29. Lavie CJ, Milani RV, Ventura HO, Romero-Corral A: Body composition and heart failure prevalence and prognosis: getting to the fat of the matter in the “obesity paradox”. Mayo Clinic Proc. 2010, 85:609–617.

    Article  Google Scholar 

  30. Curtis JP, Selter JG, Wang Y, et al.: The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med 2005, 165:55–61.

    Article  PubMed  Google Scholar 

  31. Kenchaiah S, Pocock SJ, Wang D, et al.; CHARM Investigators: Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Circulation 2007, 116:627–636.

    Article  PubMed  Google Scholar 

  32. Fonarow GC, Srikanthan P, Costanzo MR, et al.; ADHERE Scientific Advisory Committee and Investigators: An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J 2007, 153:74–81.

    Article  PubMed  Google Scholar 

  33. • Oreopoulos A, Padwal R, Kalantar-Zadeh K, et al.: Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 2008, 156:13–22. This recent meta-analysis showed that overweight and obese individuals with HF had lower cardiovascular and overall mortality than normal-weight individuals.

    Article  PubMed  Google Scholar 

  34. Artham SM, Lavie CJ, Patel HM, Ventura HO: Impact of obesity on the risk of heart failure and its prognosis. J Cardiometab Syndr 2008, 3:155–161.

    Article  PubMed  Google Scholar 

  35. •• Lavie CJ, Milani RV, Ventura HO: Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009, 53:1925–1932. This is a state-of-the-art review on obesity and its impact on cardiovascular disease.

    Article  PubMed  Google Scholar 

  36. Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC: Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 2004, 43:1439–1444.

    Article  PubMed  Google Scholar 

  37. Anker SD, Negassa A, Coats AJ, et al.: Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet 2003, 361:1077–1083.

    Article  PubMed  CAS  Google Scholar 

  38. Mohamed-Ali V, Goodrick S, Bulmer K, et al.: Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo. Am J Physiol 1999, 277:E971–975.

    PubMed  CAS  Google Scholar 

  39. Mehra MR, Uber PA, Park MH, et al.: Obesity and suppressed B-type natriuretic peptide levels in heart failure. J Am Coll Cardiol 2004, 43:1590–1595.

    Article  PubMed  CAS  Google Scholar 

  40. Rauchhaus M, Coats AJ, Anker SD: The endotoxin-lipoprotein hypothesis. Lancet 2000, 356:930–933.

    Article  PubMed  CAS  Google Scholar 

  41. Adams TD, Gress RE, Smith SC, et al.: Long-term mortality after gastric bypass surgery. N Engl J Med. 2007, 357:753–761.

    Article  PubMed  CAS  Google Scholar 

  42. •• Ramani GV, McCloskey C, Ramanathan RC, Mathier MA: Safety and efficacy of bariatric surgery in morbidly obese patients with severe systolic heart failure. Clin Cardiol 2008, 31:516–520. These elegant studies show that weight loss with bariatric surgery decreases the prevalence of metabolic syndrome and improves LV function, HF symptoms, and mortality risk.

    Article  PubMed  Google Scholar 

  43. MacMahon SW, Wilcken DE, Macdonald GJ: The effect of weight reduction on left ventricular mass. A randomized controlled trial in young, overweight hypertensive patients. N Engl J Med 1986, 314:334–339.

    Article  PubMed  CAS  Google Scholar 

  44. Lavie CJ, Milani RV, Artham SM, et al.: The obesity paradox, weight loss and coronary disease. Am J Med. 2009, 122:1106–1114.

    Article  PubMed  CAS  Google Scholar 

  45. Levy D, Larson MG, Vasan RS, et al.: The progression from hypertension to congestive heart failure. JAMA 1996, 275:1557–1562.

    Article  PubMed  CAS  Google Scholar 

  46. Moncrieff J, Lindsay MM, Dunn FG: Hypertensive heart disease and fibrosis. Curr Opin Cardiol 2004, 19:326–331.

    Article  PubMed  Google Scholar 

  47. Davis BR, Kostis JB, Simpson LM, et al.: Heart failure with preserved and reduced left ventricular ejection fraction in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Circulation 2008, 118:2259–2267.

    Article  PubMed  CAS  Google Scholar 

  48. Beckett NS, Peters R, Fletcher AE, et al.: Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008, 358:1887–1898.

    Article  PubMed  CAS  Google Scholar 

  49. Dunlay SM, Weston SA, Jacobsen SJ, Roger VL: Risk factors for heart failure: a population-based case-control study. Am J Med 2009, 122:1023–1028.

    Article  PubMed  Google Scholar 

  50. Ingelsson E, Sundström J, Arnlöv J, et al.: Insulin resistance and risk of congestive heart failure. JAMA 2005, 294:334–341.

    Article  PubMed  CAS  Google Scholar 

  51. Bonow RO, Mitch WE, Nesto RW, et al.: Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group V: management of cardiovascular-renal complications. Circulation 2002, 105:e159–164.

    Article  PubMed  Google Scholar 

  52. • Velagaleti RS, Massaro J, Vasan RS, et al.: Relations of lipid concentrations to heart failure incidence: the Framingham Heart Study. Circulation 2009, 120:2345–2351. This study shows that dyslipidemia carries a risk of causing HF, independent of its association with MI.

    Article  PubMed  CAS  Google Scholar 

  53. • Mehra MR, Uber PA, Lavie CJ, et al.: High-density lipoprotein cholesterol levels and prognosis in advanced heart failure. J Heart Lung Transplant 2009, 28:876–880. This recent study shows that low levels of HDL (<33 mg/dL) are associated with higher morbidity and mortality in patients with advanced HF than high levels of HDL (>33 mg/dL).

    Article  PubMed  Google Scholar 

  54. Dhingra R, Sesso HD, Kenchaiah S, Gaziano JM: Differential effects of lipids on the risk of heart failure and coronary heart disease: the Physicians’ Health Study. Am Heart J 2008, 155:869–875.

    Article  PubMed  CAS  Google Scholar 

  55. Kjekshus J, Pedersen TR, Olsson AG, et al.: The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease. J Card Fail 1997, 3:249–254.

    Article  PubMed  CAS  Google Scholar 

  56. Khush KK, Waters DD, Bittner V, et al.: Effect of high-dose atorvastatin on hospitalizations for heart failure: subgroup analysis of the Treating to New Targets (TNT) study. Circulation 2007, 115:576–583.

    Article  PubMed  CAS  Google Scholar 

  57. Kjekshus J, Apetrei E, Barrios V, et al.: Rosuvastatin in older patients with systolic heart failure. N Engl J Med 2007, 357:2248–2261.

    Article  PubMed  CAS  Google Scholar 

  58. Maggioni AP, Fabbri G, Lucci D, et al.; Gissi-HF Investigators: Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 2008, 372:1231–1239.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute Ochsner Clinical School - The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121, USA

    Krishna K. Gaddam

  2. Division of Heart Failure and Transplantation, John Ochsner Heart and Vascular Institute Ochsner Clinical School - The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121, USA

    Hector O. Ventura

  3. Cardiac Rehabilitation and Exercise Laboratories, Division of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute Ochsner Clinical School - The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121, USA

    Carl J. Lavie

Authors
  1. Krishna K. Gaddam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hector O. Ventura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carl J. Lavie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Krishna K. Gaddam.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gaddam, K.K., Ventura, H.O. & Lavie, C.J. Metabolic Syndrome and Heart Failure—The Risk, Paradox, and Treatment. Curr Hypertens Rep 13, 142–148 (2011). https://doi.org/10.1007/s11906-011-0179-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-011-0179-x

Keywords

Search

Navigation