Morbid Obesity as a Therapeutic Target for Heart Failure

  • Chonyang L. AlbertEmail author
Heart Failure (W Tang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Heart Failure


Purpose of review

This review will define morbid obesity and relationship between morbid obesity and heart failure syndromes. It will delve into unique challenges facing patients with dual diagnoses of heart failure and morbid obesity and examine the data that obesity should be a target in the treatment of heart failure.

Recent findings

Emerging literature has indicated the safety and efficacy of surgical weight loss in patients with heart failure. Furthermore, bariatric surgery with associated weight loss has been associated with improvements in heart failure symptoms and reverse remodeling on echocardiography. In patients with advanced heart failure, bariatric surgery has led to improvement in heart failure to obviate the need for cardiac transplantation or sufficient weight loss for cardiac transplant eligibility.


In heart failure patients who are morbidly obese, treatment of obesity is an effective therapeutic target with a myriad of potential benefits.


Obesity Bariatric surgery HFrEF HFpEF Metabolics of heart failure 


Compliance with Ethical Standards

Conflict of Interest

The author declares that there are no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

References and recommended Reading

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

  1. 1.
    Ogden CL, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. 2015;8.Google Scholar
  2. 2.
    Defining adult overweight and obesity | overweight & obesity | CDC. 2019. Available at: Accessed 2nd July 2019.
  3. 3.
    Ahmad FS, Ning H, Rich JD, Yancy CW, Lloyd-Jones DM, Wilkins JT. Hypertension, obesity, diabetes, and heart failure-free survival: the cardiovascular disease lifetime risk pooling project. JACC Heart Fail. 2016;4:911–9.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kenchaiah S, et al. Obesity and the risk of heart failure. (2009). CrossRefPubMedGoogle Scholar
  5. 5.
    Hägg S, et al. Adiposity as a cause of cardiovascular disease: a Mendelian randomization study. Int J Epidemiol. 2015;44:578–86.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C. Definition of metabolic syndrome. Circulation. 2004;109:433–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Johnson AP, et al. Body mass index, outcomes, and mortality following cardiac surgery in Ontario, Canada. J Am Heart Assoc. 2015;4.Google Scholar
  8. 8.
    Nagendran J, et al. The varying effects of obesity and morbid obesity on outcomes following cardiac transplantation. Int J Obes. 2016;2005(40):721–4.CrossRefGoogle Scholar
  9. 9.
    Lietz K, John R, Burke EA, Ankersmit JH, McCue JD, Naka Y, et al. Pretransplant cachexia and morbid obesity are predictors of increased mortality after heart transplantation. Transplantation. 2001;72:277–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Milano CA, Rogers JG, Tatooles AJ, Bhat G, Slaughter MS, Birks EJ, et al. HVAD: the ENDURANCE supplemental trial. JACC Heart Fail. 2018;6:792–802.CrossRefPubMedGoogle Scholar
  11. 11.
    Mehra MR, Uriel N, Naka Y, Cleveland JC Jr, Yuzefpolskaya M, Salerno CT, et al. A fully magnetically levitated left ventricular assist device — final report. N Engl J Med. 2019;380:1618–27.CrossRefPubMedGoogle Scholar
  12. 12.
    Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241–51.CrossRefPubMedGoogle Scholar
  13. 13.
    Caceres M, Czer LSC, Esmailian F, Ramzy D, Moriguchi J. Bariatric surgery in severe obesity and end-stage heart failure with mechanical circulatory support as a bridge to successful heart transplantation: a case report. Transplant Proc. 2013;45:798–9.CrossRefGoogle Scholar
  14. 14.
    Lockard KL, Allen C, Lohmann D, Severyn DA, Schaub RD Jr, Kauffman KE, et al. Bariatric surgery for a patient with a HeartMate II ventricular assist device for destination therapy. Prog Transplant Aliso Viejo Calif. 2013;23:28–32.CrossRefGoogle Scholar
  15. 15.
    Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Wilson PWF, et al. Impact of obesity on plasma natriuretic peptide levels. Circulation. 2004;109:594–600.CrossRefPubMedGoogle Scholar
  16. 16.
    Das SR, Drazner MH, Dries DL, Vega GL, Stanek HG, Abdullah SM, et al. Impact of body mass and body composition on circulating levels of natriuretic peptides. Circulation. 2005;112:2163–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Sugisawa T, et al. Association of plasma B-type natriuretic peptide levels with obesity in a general urban Japanese population: the Suita Study. Endocr J. advpub, 2010;1005060418–1005060418.Google Scholar
  18. 18.
    Beamish AJ, Olbers T, Kelly AS, Inge TH. Cardiovascular effects of bariatric surgery. Nat Rev Cardiol. 2016;13:730–43.CrossRefGoogle Scholar
  19. 19.
    Vest AR, Heneghan HM, Schauer PR, Young JB. Surgical management of obesity and the relationship to cardiovascular disease. Circulation. 2013;127:945–59.CrossRefPubMedGoogle Scholar
  20. 20.
    Appel LJ, Clark JM, Yeh HC, Wang NY, Coughlin JW, Daumit G, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365:1959–68.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Pham D, De Albuquerque Rocha N, McGuire DK, Neeland IJ. Impact of empagliflozin in patients with diabetes and heart failure. Trends Cardiovasc Med. 2017;27:144–51.CrossRefPubMedGoogle Scholar
  22. 22.
    Andersen T, Stokholm KH, Backer OG, Quaade F. Long-term (5-year) results after either horizontal gastroplasty or very-low-calorie diet for morbid obesity. Int J Obes. 1988;12:277–84.PubMedGoogle Scholar
  23. 23.
    Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163(5). Available at: Accessed 28th June 2019.
  24. 24.•
    Berger S, et al. Bariatric surgery among patients with heart failure: a systematic review and meta-analysis. Open Heart. 2018;5. Systematic review of recent populations suggesting bariatric surgery is associated with improvements in quality of life, re-duced hospital admissions, and improvements in heart failure symptoms in patients with obese patients with HF.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.•
    Shimada YJ, Tsugawa Y, Brown DFM, Hasegawa K. Bariatric surgery and emergency department visits and hospitalizations for heart failure exacerbation: population-based, self-controlled series. J Am Coll Cardiol. 2016;67:895–903 Bariatric surgery in HF patients is associated with reduction in emergency department visits and heart failure hospitalizations.CrossRefPubMedGoogle Scholar
  26. 26.•
    Vest Amanda R, et al. Clinical and echocardiographic outcomes after bariatric surgery in obese patients with left ventricular systolic dysfunction. Circ Heart Fail. 2016;9:e002260 Patients with left ventricular ejection fraction < 50% undergoing bariatric surgery compared with matched cohort of patients without surgery demonstrating greater improvement in LV ejection fraction post-op. No excess mortality detected at 1 year compared with bariatric surgery patients without depressed ejection fraction.PubMedGoogle Scholar
  27. 27.
    Lim C-P, Fisher OM, Falkenback D, Boyd D, Hayward CS, Keogh A, et al. Bariatric surgery provides a ‘bridge to transplant’ for morbidly obese patients with advanced heart failure and may obviate the need for transplantation. Obes Surg. 2016;26:486–93.CrossRefPubMedGoogle Scholar
  28. 28.
    Wikiel KJ, McCloskey CA, Ramanathan RC. Bariatric surgery: a safe and effective conduit to cardiac transplantation. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10:479–84.CrossRefGoogle Scholar
  29. 29.
    Miranda WR, et al. Impact of bariatric surgery on quality of life, functional capacity, and symptoms in patients with heart failure. Obes Surg. 2013;23:1011–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Vest AR, Heneghan HM, Agarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart Br Card Soc. 2012;98:1763–77.Google Scholar
  31. 31.
    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;31:516–20.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Alpert MA, Terry BE, Kelly DL. Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol. 1985;55:783–6.CrossRefGoogle Scholar
  33. 33.
    Department of General Surgery, University General Hospital Gregorio Marañón, Calle del Doctor Esquerdo, 46, 28007 Madrid, Spain et al. Improvement of ventricular ejection fraction after bariatric surgery in obese patients with dilated cardiomyopathy. Obes Res - Open J. 2015;1:1–3.Google Scholar
  34. 34.
    Samaras K, Connolly SM, Lord RV, Macdonald P, Hayward CS. Take heart: bariatric surgery in obese patients with severe heart failure. Two case reports. Heart Lung Circ. 2012;21:847–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Grapsa J, et al. The effect of bariatric surgery on echocardiographic indices: a review of the literature. Eur J Clin Investig. 2013;43:1224–30.Google Scholar
  36. 36.
    Iyengar S, Leier CV. Rescue bariatric surgery for obesity-induced cardiomyopathy. Am J Med. 2006;119:e5–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Mukerji R, Petruc M, Fresen JL, Terry BE, Govindarajan G, Alpert MA. Effect of weight loss after bariatric surgery on left ventricular mass and ventricular repolarization in normotensive morbidly obese patients. Am J Cardiol. 2012;110:415–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Leviner DB, Keidar A, Ben-Gal T, Medalion B. Cardiac function recovery following LVAD implantation and bariatric surgery in a morbidly obese patient. J Card Surg. 2014;29:740–2.CrossRefGoogle Scholar
  39. 39.
    Reigle J. Heart failure, Obesity and Bariatric Surgery. Prog Cardiovasc Nurs. 2009;24:36–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Ristow B, Rabkin J, Haeusslein E. Improvement in dilated cardiomyopathy after bariatric surgery. J Card Fail. 2008;14:198–202.CrossRefPubMedGoogle Scholar
  41. 41.
    Chaudhry UI, Kanji A, Sai-Sudhakar CB, Higgins RS, Needleman BJ. Laparoscopic sleeve gastrectomy in morbidly obese patients with end-stage heart failure and left ventricular assist device: medium-term results. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2015;11:88–93.CrossRefGoogle Scholar
  42. 42.
    Jeng EI, Aranda JM, Ahmed M, Klodell CT. Left ventricular assist device and bariatric surgery: a bridge to heart transplant by weight and waiting time reduction. J Card Surg. 2016;31:120–2.CrossRefGoogle Scholar
  43. 43.
    Algahim MF, Sen S, Taegtmeyer H. Bariatric surgery to unload the stressed heart: a metabolic hypothesis. Am J Physiol Heart Circ Physiol. 2012;302:H1539–45.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Vest AR, Young JB. Should we target obesity in advanced heart failure? Curr Treat Options Cardiovasc Med. 2014;16:284.CrossRefPubMedGoogle Scholar
  45. 45.
    Fenske W, Athanasiou T, Harling L, Drechsler C, Darzi A, Ashrafian H. Obesity-related cardiorenal disease: the benefits of bariatric surgery. Nat Rev Nephrol. 2013;9:539–51.CrossRefPubMedGoogle Scholar
  46. 46.
    Leichman JG, Wilson EB, Scarborough T, Aguilar D, Miller CC III, Yu S, et al. Dramatic reversal of derangements in muscle metabolism and left ventricular function after bariatric surgery. Am J Med. 2008;121:966–73.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Johnson BL, et al. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg. 2013;216:545–56; discussion 556–558.CrossRefGoogle Scholar
  48. 48.
    Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes — 5-year outcomes. N Engl J Med. 2017;376:641–51.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineCleveland ClinicClevelandUSA
  2. 2.Heart and Vascular Institute, Kaufman Center for Heart FailureCleveland ClinicClevelandUSA

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