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The epidemic of obesity and diabetes in the Western population will confront us with a different type of heart failure.
One the one hand, obesity and diabetes increase the risk of coronary artery disease and myocardial infarction, leading to our well known type of heart failure with ventricular dilatation and impaired systolic function.
On the other hand, the growing epidemic of obesity and diabetes can also result in heart failure without macrovascular coronary artery disease. This type of heart failure is generally characterised by preserved systolic function, but impaired diastolic function.
Major causes of this "metabolic heart failure" are mitochondrial dysfunction, collagen deposition, oxidative stress, formation of advanced glycation endproducts, microvascular alterations, and cardiac autonomic neuropathy. Therefore, we will have to change our views and search for different treatment options.
Teaching objective of the lecture:
The epidemic of obesity and diabetes in the Western population will lead to an unfamiliar type of heart failure, needing a different approach with novel treatment options.
Take home messages:
- Obesity and diabetes increase the risk of acute myocardial infarction leading to our well known type of heart failure (LV-dilatation and impaired systolic function)
- In addition, obesity and diabetes can result in heart failure without macrovascular coronary artery disease, generally with preserved systolic function
- This type of "metabolic heart failure" will need a different approach with different treatment options.