Content area
Full Text
Correspondence to Professor Prashanthan Sanders, Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide; [email protected]
Introduction
Obesity is a modern-day epidemic affecting more than one-third of the population worldwide.1 Similarly, heart failure (HF) is a major public health problem with an estimated lifetime risk of one in five. Obesity is considered to contribute to the increasing incidence of all subgroups of HF.2 However, there have been variable reports on the impact of obesity on HF prognosis.3 Though wasting in terminal HF patients has been associated with poor prognosis, a recent bariatric surgery study has shown that intentional weight loss in obese patients is associated with reduced risk of incident HF.4 5 The present ACCF/AHA society guidelines appreciate that obesity is a risk factor for HF but do not have firm recommendations on weight management in HF.6
Therefore, a potential beneficial impact of intentional weight loss in obese patients continues to be a issue of conjecture but worth investigating given the benefit observed in other patient populations such as atrial fibrillation (AF).7 8 The purpose of this systematic review and meta-analysis is to evaluate the relationship between obesity and the incidence of HF and its impact on prognosis in HF in the general population and to explore the impact of intentional weight loss in obese individuals on indices of cardiac structure and function by bariatric surgery.
Methods
This systematic review complies with the Meta-analysis of Observational Studies in the Epidemiology group and Preferred Reporting Items for Systematic Review and Meta-Analysis statements. The meta-analysis was registered with PROSPERO International register for systematic reviews (APP 74412).
Search strategy
The English scientific literature was searched using PubMed, Embase and Web of Science between the period 1 January 1950 to 3 April 2018 with the assistance of an experienced librarian. The following keywords were used ‘Obesity’, ‘abdominal obesity’, ‘Diabetic Obesity’, ‘Metabolic Syndrome X’, ‘Morbid Obesity’, body mass index’, ‘obesity hypoventilation syndrome’, ‘cardiorenal syndrome’, ‘congestive heart failure’, ‘heart failure with preserved ejection fraction’, ‘diastolic dysfunction’ ‘heart ventricle failure’, ‘bariatric surgery’, ‘intentional weight loss’, ‘left ventricle’, ‘left ventricular hypertrophy’, ‘cardiac hypertrophy’, ‘natriuretic peptide’, ‘BNP’ and ‘NT-BNP’. The details are provided in online supplementary 1 The retrieved references were exported to EndNote X7.3, and duplicate...