OBESITY AND HEART FAILURE: EMERGING PARADIGMS IN PHARMACOLOGICAL AND METABOLIC MANAGEMENT

Abstract

Obesity has become a key phenotypic determinant of heart failure, particularly heart failure with preserved ejection fraction (HFpEF), affecting up to half of patients and driving cardiac remodeling, low-grade inflammation, metabolic dysfunction, and exercise intolerance. This narrative review critically assessed studies published between 2020 and 2025 in PubMed, LILACS, and BVS, following adapted PRISMA recommendations. From 563 records screened, 26 high-relevance articles were included. Evidence shows that SGLT2 inhibitors reduce major cardiovascular events by approximately 20% in HFpEF, while GLP-1 receptor agonists and tirzepatide achieve >10% weight loss and up to 38% reductions in composite outcomes, along with improvements in functional capacity and quality of life. In interventional strategies, bariatric surgery reduced cardiovascular mortality by up to 50%, and structured exercise and rehabilitation programs increased peak VO₂ by 10–15%, even in the absence of significant weight loss. Collectively, these findings support a paradigm shift in which obesity transitions from a mere risk factor to a therapeutic target. Integrating modern pharmacology, surgical interventions, and lifestyle programs defines a cardiometabolic model of care that emphasizes precision and personalization, with particular importance for regions facing challenges of access and healthcare equity.