ABSTRACT
Clinically important changes in body weight are common in heart failure and impact daily
patient management. Overweight and obesity, insulin resistance, and metabolic syndrome
are increasing in prevalence and contribute directly to the development and progression of
left ventricular dysfunction. At the same time, improved treatment of chronic heart failure
has resulted in increasing numbers of patients with advanced disease and cardiac cachexia.
Mechanisms underlying weight gain and loss in heart failure are complex, and an evolving
understanding of pathophysiology has suggested novel targets of therapy. Standard
pharmacologic strategies include titration of neurohormonal antagonists and diuretics
while recognizing the limited reliability of the clinical evaluation. Sodium and fluid
restriction, moderation of alcohol use, and exercise are equally important components of
care for the majority of patients with heart failure, regardless of body weight. For obese
patients, marked weight loss may contribute to reverse ventricular remodeling.
