OBESITY AND THE HEART

Obesity can result in alterations in cardiac structure and function ev en in the absence of systemic hypertension and underlying organic hear t disease. Increased total blood volume creates a high cardiac output state that may cause ventricular dilatation and ultimately eccentric h ypertrophy of the left (and possibly the right) ventricle. Eccentric l eft ventricular (LV) hypertrophy produces diastolic dysfunction. Systo lic dysfunction may ensue due to excessive wall stress if wall thicken ing fails to keep pace with dilatation. This disorder is referred to a s obesity cardiomyopathy. The presence of systemic hypertension in obe se individuals facilitates development of LV dilatation and hypertroph y. Congestive heart failure may occur in such individuals, and may be attributable to LV diastolic dysfunction or to combined LV diastolic a nd systolic dysfunction. The sleep apnea/obesity hypoventilation syndr ome occurs in 5% of morbidly obese individuals and is potentially life -threatening. Treatment of obesity cardiomyopathy consists of weight l oss, salt restriction, and diuretics. Digitalis and vasodilators may b e useful in selected cases. Central obesity is probably a risk factor for the development of coronary heart disease. Alterations in lipid an d insulin metabolism may facilitate development of coronary heart dise ase in obese patients.