Avaliação da Obesidade como Fator de risco para Insuficiência cardíaca : Overview de Revisões Sistemáticas

Abstract

Heart failure is a public health problem, defined as a complex clinical syndrome in which the heart is unable to pump enough blood to meet tissue metabolic needs, or does so under high filling pressures. This syndrome can be caused by structural or functional alterations. The HF is the common pathway of cardiovascular diseases, being the main cause of morbimortality in Brazil. The overweight and obese population has an increased risk of mortality from several cardiovascular diseases, including HF, and may even be related to the development and aggravation of these clinical conditions. However, some studies point to the existence of an "obesity paradox" where there could be a protective effect on the relative risk of death by HF in these populations with high BMI. In this way, the present study aimed to investigate obesity as a risk factor for heart failure. For this, an overview of systematic reviews was carried out by selecting articles from the following databases: "Pubmed", "Scopus" and "SciElo", using the following descriptors, in Portuguese and English, according to the search strategy: (("systematic review" OR “revisão sistemática” OR "meta-analysis" OR meta-analysis OR “meta-análise” OR meta-analysis) AND (“Cardiac insufficiency” OR “Heart Failure” OR “Heart Decompensation” OR “Insuficiência Cardíaca” OR “Descompensação Cardíaca” OR “Falência Cardíaca” OR “Insuficiencia cardíaca”) AND (Obesity OR Obesidad OR Obesidade)). The Boolean operators "OR" and "AND" were used in the search strategies. A total of 615 articles were found from this initial search, leaving 59 articles for full-text reading, of which 22 articles were included for data extraction using the predefined inclusion criteria. From these 22 studies 73% were meta-analysis and 64% of the studies are of high methodological quality according to AMSTAR-2. Corroborating the facts already pointed out in the literature, overweight and obesity have demonstrated a close relationship with the onset and increase of mortality by HF, studies have even been found that point to a gene interference in this relationship. In studies reporting on the obesity paradox, the results pointed to a momentary protection from mortality risk. However, new studies with better methodological quality are needed to provide more robust evidence about the real benefits of overweight and obesity in patients with HF.