Dr.Kamal Waheeb AlGhalayini MD, SCC Med. MSc-Card Associate professor, Consultant Cardiology. Head non-invasive lab. Vice dean for clinical affaires

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1 Dr.Kamal Waheeb AlGhalayini MD, SCC Med. MSc-Card Associate professor, Consultant Cardiology. Head non-invasive lab. Vice dean for clinical affaires King Abdulaziz University.

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4 Doc, I am fat because my hormones are out of whack. I know I don t eat too much. Can you check out what s wrong with me and give me a pill to fix it..

5 I don t think I need to change what I am eating. I am going to work out and lose it that way.

6 Medical Complications of Obesity Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Gall bladder disease Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Skin Gout Idiopathic intracranial hypertension Stroke Cataracts Coronary heart disease Diabetes Dyslipidemia Hypertension Severe pancreatitis Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Phlebitis venous stasis

7 The adverse relationship between marked obesity and changes in cardiac structure and function has been noted since 1933 Obesity associated cardiac disease can be associated with DM. HTN and metabolic syndromes or independent.

8 Higher incidence of idiopathic, dilated cardiomyopathy in obese patients (average body weight of 130 kg compared with lean patients (average body weight of 71 kg) (76.7% versus 35.5%, p < )

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18 Obesity is an independent predictor of the development of HF via adverse effects on cardiac structure and (LV) systolic and diastolic functions Obesity also been implicated as a major risk factors for hypertension HTN,CHD), both of which are strongly related to the development of heart failure HF 1.avie C.J., et al(2009) J Am Coll Cardiol 53:

19 Obesity Facts 7(2):82-95

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22 Association of BMI categories with adjusted incidence rates for different CVD subtypes. Chiadi E. Ndumele et al. J Am Heart Assoc 2016;5:e Chiadi E. Ndumele et al.

23 Prevalence of heart failure in 5,881 Framingham participants according to obesity Carl J. Lavie et al. JCHF 2013;1: American College of Cardiology Foundation

24 Carl J. Lavie et al. JCHF 2013;1: Risk-adjusted survival curves for the 4 body mass index categories at 5 years in a study of 1,203 patients with moderate to severe heart failure. Survival was significantly better in the overweight and obese categories.

25 American College of Cardiology Foundation Carl J. Lavie et al. JCHF 2013;1:93-102

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30 DM conferred twice the risk in men and nearly five times the risk in women for the development of heart failure The incidence of heart failure is 2.5 times higher in diabetics than the general population diabetes was shown to be an independent risk factor for the development of heart failure 1Kannel WB, et aljama May 11; 241(19): ,2 Nichols GA, Gullion CM, et al Diabetes Care Aug; 27(8): ,3 Gottdiener Jset al J Am Coll Cardiol May; 35(6): , 4Aronow WS, et alchest Mar; 115(3):867-8., 5 Lind M, et al Lancet Jul 9; 378(9786):140-6.

31 Elderly (>65 years0, 39 % of diabetic patients developed heart failure compared to 23 % of non-diabetics after 3.5 years An increase in HgbA 1c from 6.5 % to 10.5 % increases the risk of developing heart failure nearly 4-fold 1Kannel WB, et aljama May 11; 241(19): ,2 Nichols GA, Gullion CM, et al Diabetes Care Aug; 27(8): ,3 Gottdiener Jset al J Am Coll Cardiol May; 35(6): , 4Aronow WS, et alchest Mar; 115(3):867-8., 5 Lind M, et al Lancet Jul 9; 378(9786):140-6.

32 Patients with HF had glucose metabolism increased risk for developing diabetes, 29 % vs 18 %, compared to the general population 1 25% HF patients have concomitant diabetes and up to 40 % in patients admitted with acute decompensated HF 2 patients with HF and Preserved Ejection Fraction (HFpEF) have higher prevalence of DM reaching nearly 40 % 3 Vermes E, et alcirculation Mar 11; 107(9): ,Dei Cas et l JACC Heart Fail Feb; 3(2):, Owan TE, et al N Engl J Med Jul 20; 355(3):251-9.

33 Cardiac Failure Review, 2015;1(1):8 10

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38 The co-existence of heart failure and diabetes has significant worse prognosis than heart failure alone 1 The diagnosis of diabetes in heart failure patients results in increased cardiovascular mortality, higher readmission rates and increased hospital lengths of stay 2 1Sarma S, Et al Eur J Heart Fail. 2013;15: ,2. Nieminen et al. Eur Heart J. 2006;27: ,3Bertoni AG, Hundley WG, et al Diabetes Care Mar; 27(3): , 4MacDonald et al Eur Heart J Jun; 29(11): , 5 Das SR et al Am Heart J Nov; 148(5):883-8.

39 The presence of diabetes in heart failure confers a significantly higher rate of mortality compared to those without diabetes, 45 % versus 24 % respectively, at 5 years. 3 DM patients with HFpEF had worse outcomes compared with those with DM and HFrEF 4 Patients with asymptomatic ischaemic cardiomyopathy had poor prognosis 5 1Sarma S, Et al Eur J Heart Fail. 2013;15: ,2. Nieminen et al. Eur Heart J. 2006;27: ,3Bertoni AG, Hundley WG, et al Diabetes Care Mar; 27(3): , 4MacDonald et al Eur Heart J Jun; 29(11): , 5 Das SR et al Am Heart J Nov; 148(5):883-8.

40 The obesity and diabetes Epidemic in Heart failure : any solutions in sight??

41 Thank you