cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2017-2-73-80cardiovascular-495Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMРОЛЬ ДИЕТЫ И ФИЗИЧЕСКОЙ АКТИВНОСТИ В ТЕРАПИИ ПАЦИЕНТОВ С СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ С СОХРАНЕННОЙ ФРАКЦИЕЙ ВЫБРОСАTHE ROLE OF DIET AND PHYSICAL ACTIVITY IN THERAPY OF CARDIOVASCULAR PATIENTS WITH NORMAL EJECTION FRACTIONДрапкинаО. М.DrapkinaO. M.

д.м.н., профессор, чл.-корр. РАН, первый заместитель директора по научной и лечебной работе

профессор кафедры факультетской терапии,

Москва

Moscow

drapkina@bk.ruДуболазоваЮ. В.DuboglazovaYu. V.

к.м.н., с.н.с.,

Москва

Moscow

yuliadubolazova@rambler.ruЕлиашевичС. О.EliashevichS. O.

лаборант-исследователь,

Москва

Moscow

elsofol@yandex.ruФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России; ФГАОУ ВО “Первый Московский государственный медицинский университет имени И.М. Сеченова” Минздрава России (Сеченовский Университет)National Research Center for Preventive Medicine of the Ministry of Health; I. M. Sechenov First Moscow State Medical University of the Ministry of HealthФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава РоссииРоссияNational Research Center for Preventive Medicine of the Ministry of HealthRussian Federation2017200420171627380Copyright © Драпкина О.М., Дуболазова Ю.В., Елиашевич С.О., 20172017Драпкина О.М., Дуболазова Ю.В., Елиашевич С.О.Drapkina O.M., Duboglazova Y.V., Eliashevich S.O.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/495

Высокий индекс массы тела — доказанный фактор риска сердечной недостаточности (СН) как со сниженной фракцией выброса (ФВ), так и с сохраненной ФВ. В качестве первичной профилактики, а также в целях предотвращения прогрессирования хронической СН, лечение сопутствующей патологии, такой как артериальная гипертония, сахарный диабет, ожирение рассматривают как патогенетически обусловленный подход. Безопасность и эффективность терапии ожирения при СН с сохраненной ФВ изучены мало. Не утихает дискуссия о наличии так называемого “парадокса ожирения”, согласно которому повышение индекса массы тела ассоциировано с низким риском общей смертности. Как известно, ожирение ассоциировано с гипертрофией и дисфункцией левого желудочка (ЛЖ). Длительность существования морбидного ожирения влияет на обратимость изменений ЛЖ в ответ на снижение веса. Важно также, что при наличии ожирения наблюдается четырехкратное увеличение распространенности обструктивного апноэ во сне, которое участвует в патогенез СН. В статье представлен обзор имеющихся публикаций о безопасности и эффективности применения немедикаментозных методов лечения ожирения при СН с сохраненной ФВ ЛЖ. 

High body mass index is a proven risk factor for heart failure (HF) with either reduced and normal ejection fraction (EF). As primary prevention, and to prevent progression of chronic HF, it is pathogenetically evident to manage comorbidities as arterial hypertension, diabetes, obesity. Safety and efficacy of obesity treatment for HF with normal EF course is not studied well. There is still a discussion on the “obesity paradox” taken that body mass index increase is associated with lower risk of overall mortality. It is known that obesity is related to hypertrophy and dysfunction of the left ventricle (LV). Duration of morbid obesity course influences the reversibility of LV changes in response to weight reduction. It is important as well, that in obesity there is four-time growth of prevalence of obstructive sleep apnea that plays role in HF pathogenesis. The article provides review of recent publications on safety and efficacy of non-medication methods for obesity treatment in HF with normal EF.

сердечная недостаточность с сохраненной фракцией выбросаожирениедиетафизическая активностьheart failure with normal ejection fractionobesitydietphysical activityReferencesPonikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J Advance Access 2016; 1-85.Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J Advance Access 2016; 1-85.Shah J, Katz H, Deo C, et al. Phenotypic Spectrum of Heart Failure with Preserved Ejection Fraction. Heart Fail Clin 2014; 10(3): 407-18.Shah J, Katz H, Deo C, et al. Phenotypic Spectrum of Heart Failure with Preserved Ejection Fraction. Heart Fail Clin 2014; 10(3): 407-18.Samson R, Jaiswal A, Ennezat V, et al. Clinical Phenotypes in Heart Failure with Preserved Ejection Fraction. J Am Heart Assoc 2016; 5(1): 24-30.Samson R, Jaiswal A, Ennezat V, et al. Clinical Phenotypes in Heart Failure with Preserved Ejection Fraction. J Am Heart Assoc 2016; 5(1): 24-30.Yusuf S, Koon KT, Pogue J, et al. Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events. N Engl J Med 2008; 358: 1547-59.Yusuf S, Koon KT, Pogue J, et al. Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events. N Engl J Med 2008; 358: 1547-59.Oparil S, Kjeldsen SE, Hedner T, et al. ONTARGET, TRANSCEND and PROFESS — Clarifying, confusing or misleading? Blood Pressure 2009; 18(1-2): 4-6.Oparil S, Kjeldsen SE, Hedner T, et al. ONTARGET, TRANSCEND and PROFESS — Clarifying, confusing or misleading? Blood Pressure 2009; 18(1-2): 4-6.Nedogoda S. PPAR-γ-activation — the key benefit of telmisartan and it’s combination. Atmosphere. Cardiology News 2016; 1: 21-5.Nedogoda S. PPAR-γ-activation — the key benefit of telmisartan and it’s combination. Atmosphere. Cardiology News 2016; 1: 21-5.Neutel JM and the TEAMSTA Severe HTN Study Investigators. Single-Pill Combination of Telmisartan/Amlodipine in Patients With Severe Hypertension: Results From the TEAMSTA Severe HTN Study. J Clin Hypertens 2012; 14(4): 206-15.Neutel JM and the TEAMSTA Severe HTN Study Investigators. Single-Pill Combination of Telmisartan/Amlodipine in Patients With Severe Hypertension: Results From the TEAMSTA Severe HTN Study. J Clin Hypertens 2012; 14(4): 206-15.Upadhya B, Haykowsky J, Eggebeen J, Kitzman W. Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem. J Geriatr Cardiol 2015; 12(3): 294-304.Upadhya B, Haykowsky J, Eggebeen J, Kitzman W. Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem. J Geriatr Cardiol 2015; 12(3): 294-304.Haass M, Kitzman DW, Anand IS, et al. Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction. Results from the Ibesartan in Patients with Preserved Ejection Fraction (I-PRESERVE) Trial. Circ Heart Fail 2011; 4: 324-31.Haass M, Kitzman DW, Anand IS, et al. Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction. Results from the Ibesartan in Patients with Preserved Ejection Fraction (I-PRESERVE) Trial. Circ Heart Fail 2011; 4: 324-31.Neeland I, Gupta S, Ayers CR, et al. Relation of regional fat distribution to left ventricular structure and function. Circ Cardiovasc Imaging 2013; 6: 800-7.Neeland I, Gupta S, Ayers CR, et al. Relation of regional fat distribution to left ventricular structure and function. Circ Cardiovasc Imaging 2013; 6: 800-7.Arias MA, García-Río F, Alonso-Fernández A, et al. Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation 2005; 112: 375-83.Arias MA, García-Río F, Alonso-Fernández A, et al. Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation 2005; 112: 375-83.Upadhya B, Haykowsky MJ, Eggebeen J, et al. Sarcopenic Obesity and the Pathogenesis of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction. Curr Heart Fail Rep 2015; 12(3): 205-14.Upadhya B, Haykowsky MJ, Eggebeen J, et al. Sarcopenic Obesity and the Pathogenesis of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction. Curr Heart Fail Rep 2015; 12(3): 205-14.Baumgartner RN, Wayne SJ, Waters DL, et al. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 2004; 12: 1995-2004.Baumgartner RN, Wayne SJ, Waters DL, et al. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 2004; 12: 1995-2004.Bowen S, Rolim NP, Fischer T, et al. Heart failure with preserved ejection fraction induces molecular, mitochondrial, histological, and functional alterations in rat respiratory and limb skeletal muscle. Eur J Heart Fail 2015; 10: 55-70.Bowen S, Rolim NP, Fischer T, et al. Heart failure with preserved ejection fraction induces molecular, mitochondrial, histological, and functional alterations in rat respiratory and limb skeletal muscle. Eur J Heart Fail 2015; 10: 55-70.Dalos D, Mascherbauer J. Functional Status, Pulmonary Artery pressure, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction. JACC 2016; 68(2): 189-99.Dalos D, Mascherbauer J. Functional Status, Pulmonary Artery pressure, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction. JACC 2016; 68(2): 189-99.Weisbrod RM, Shiang T, Al Sayah L, et al. Arterial stiffening precedes systolic hypertension in diet-induced obesity. Hypertension 2013; 62: 1105-10.Weisbrod RM, Shiang T, Al Sayah L, et al. Arterial stiffening precedes systolic hypertension in diet-induced obesity. Hypertension 2013; 62: 1105-10.Nordstrand N, Gjevestad E, Hertel JK, et al. Arterial stiffness, lifestyle intervention and a low-calorie diet in morbidly obese patients-a nonrandomized clinical trial. Obesity 2013; 21: 690-7.Nordstrand N, Gjevestad E, Hertel JK, et al. Arterial stiffness, lifestyle intervention and a low-calorie diet in morbidly obese patients-a nonrandomized clinical trial. Obesity 2013; 21: 690-7.Sanguankeo A, Lazo M, Upala S, et al. Effects of visceral adipose tissue reduction on CVD risk factors independent of weight loss: The Look AHEAD study. Endocrine Research 2016; 3: 10-20,Sanguankeo A, Lazo M, Upala S, et al. Effects of visceral adipose tissue reduction on CVD risk factors independent of weight loss: The Look AHEAD study. Endocrine Research 2016; 3: 10-20,Kitzman DW, Brubaker P, Morgan T, et al. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial. JAMA 2016; 315(1): 36-46.Kitzman DW, Brubaker P, Morgan T, et al. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial. JAMA 2016; 315(1): 36-46.Kosek DJ, Kim JS, Petrella JK, et al. Efficacy of 3 days/wk resistance training on myofiber hypertrophy and myogenic mechanisms in young vs. older adults. J Appl Physiol 2006; 101: 531-44.Kosek DJ, Kim JS, Petrella JK, et al. Efficacy of 3 days/wk resistance training on myofiber hypertrophy and myogenic mechanisms in young vs. older adults. J Appl Physiol 2006; 101: 531-44.Kitzman D, Brubaker P, Morgan T, et al. Exercise training in older patients with heart failure and preserved ejection fraction. Circ Heart Fail 2010; 3: 659-67.Kitzman D, Brubaker P, Morgan T, et al. Exercise training in older patients with heart failure and preserved ejection fraction. Circ Heart Fail 2010; 3: 659-67.Kitzman D, Brubaker P, Herrington D, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: A randomized, controlled, single-blind trial. JACC 2013; 62: 584-92.Kitzman D, Brubaker P, Herrington D, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: A randomized, controlled, single-blind trial. JACC 2013; 62: 584-92.Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease. Circ Res 2016; 118: 1752-70.Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease. Circ Res 2016; 118: 1752-70.Haass M, Kitzman DW, Anand IS, et al. Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction. Results from the Ibesartan in Patients with Preserved Ejection Fraction (I-PRESERVE) Trial. Circ Heart Fail 2011; 4: 324-31.Haass M, Kitzman DW, Anand IS, et al. Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction. Results from the Ibesartan in Patients with Preserved Ejection Fraction (I-PRESERVE) Trial. Circ Heart Fail 2011; 4: 324-31.Zamora E, Lupón J, Enjuanes C, et al. No benefit from the obesity paradox for diabetic patients with heart failure. Eur J Heart Fail 2016; 10: 34-45.Zamora E, Lupón J, Enjuanes C, et al. No benefit from the obesity paradox for diabetic patients with heart failure. Eur J Heart Fail 2016; 10: 34-45.Padwal R, McAlister FA, McMurray JJV, et al. The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data. Intern J Obesity 2014; 38: 1110-4.Padwal R, McAlister FA, McMurray JJV, et al. The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data. Intern J Obesity 2014; 38: 1110-4.Aune D, Sen A, Prasad M, et al. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016; 31: 1-17.Aune D, Sen A, Prasad M, et al. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016; 31: 1-17.

The authors declare that there are no conflicts of interest present.