Progressive Diastolic Dysfunction and Heart Failure is associated with Obesity

Diastolic dysfunction is prevalent in obese people age 45  years and older and worsens with time.

In a recent JAMA article only 25% had a BMI <25% and >75% were treated with cardiovascular medications:

There are several conclusions that can be drawn from this article:

  • This is a study of heart failure as a result of obesity.
  • Is Obesity the new body habitus for Americans age 45 years and older?
  • If so, treatment for obesity has yet to become a standard goal of therapy for what has become a new epidemic.
  • Medications don't protect against progression of cardiac dysfunction in the obese.

Dr T

(From: Progression of Left Ventricular Diastolic Dysfunction and Risk of Heart Failure, Garvan C. Kane, MD, PhD et al. JAMA. 2011;306(8):856-863)



Hi Jane,

Re: diagnosis of diastolic dysfunction in the last 10 years, I am sure you are correct.

The authors of this concluded: "... There was a marked progression of diastolic dysfunction: 23% of participants showed worse diastolic function, 68% were unchanged, and 9% improved. A similar pattern of worsening diastolic function also was observed in a subset of healthy participants. Incident heart failure during 6.3 (SD, 2.3) years of follow-up was associated with age, hypertension, diabetes, coronary artery disease, and diastolic dysfunction..."

Obesity, though observed, was not remarked upon. I believe there are several reasons for this omission:

  1. Almost every patient was either overweight or obese and this did not change from the first to second observation;
  2. Obesity treatments short of bariatric surgery (or prevention) is not effective, or even considered by either patient or physician.

Many years ago, as one of the start-up participants, I suggested to the statistician involved with the The Northern New England Cardiovascular Disease Study Group (NNECDSG) that Obesity was a significant independant risk factor for (cardiac) surgery. I was told in no uncertain terms I was wrong; only years later increasing numbers of operated obese patients comfirmed statistically what I had known long before.

While a very useful tool, statistics sometimes cannot observe the obvious!

Dr T


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