— By Andrea M. Pampaloni, Ph.D.
Cardiomyopathy is exacerbated by obesity, and patients with severe obesity are at high risk.
Cardiomyopathy, a disease of the heart muscle, reduces the heart’s ability to pump blood well and can lead to heart failure. This is exacerbated by obesity, which also makes the heart pump harder, and patients with severe obesity are at high risk. There are several types off cardiomyopathy, but among the most common are:
- Dilated Cardiomyopathy (DCM): The heart muscle becomes thin and the left ventricle dilates. The heart cannot compress efficiently, which reduces the amount of blood pumped to the body.
- Hypertrophic Cardiomyopathy (HCM): The heart muscle is thickened, typically in the left ventricle. This can occur at the septum, posterior wall, apex, or throughout the entire left ventricle, and can result in outflow tract obstruction.
- Restrictive Cardiomyopathy (RCM): The heart muscle becomes rigid, and although it is still able to squeeze well, it cannot relax between beats, causing abnormal rhythm. It becomes difficult for the heart to fill with blood, which backs up into the circulatory system.
- Another type, Obesity Cardiomyopathy (OCM), is often viewed as a sub-type or cause of DCM (see above). It is characterized by alterations to the left ventricle, including dilation, increased wall stress, eccentric hypertrophy, and diastolic dysfunction. Right ventricular structure and function also may be affected. OCM is most likely to occur in patients with severe, long-term obesity, and can lead to progressive congestive heart failure and sudden cardiac death.
Weight Loss is Key to Treatment
Weight loss is strongly recommended for people with cardiovascular issues. Excess weight increases the heart’s workload and could cause the heart muscle to thicken, compounding the risk of heart failure. Losing weight, especially visceral fat or fat that may be hidden around the heart, reduces the workload of the heart, thus lowering blood pressure and other risk factors.
A Very Low Calorie Diet (VLCD), such as New Direction Advanced, has been found to be effective for weight loss and risk reduction. A study of older adults following a VLCD indicated significant improvements in HbA1c, total cholesterol, triglycerides, systolic blood pressure, and improvements in multiple cardiovascular risk markers, even with a reduction in medication.1
As with all patients, medical oversight is critical for patients with cardiovascular problems. A recent study found that VLCDs “are highly effective” for patients with cardiac disease; however, careful monitoring, especially during the first few weeks, is imperative as heart functions may decline during this period before improving.2 Indeed, another study found that after following a VLCD for 16 weeks, patients showed sustained cardiac remodeling and improved diastolic function more than a year later, despite weight regain on a regular diet.3
The continued rise in obesity means a corresponding rise in cardiovascular and other diseases. Weight loss and lifestyle change offers a nonpharmacological solution that allows the patient a voice in their treatment. As such, all options should be presented to provide alternatives and to help minimize and reverse the rate of obesity and related poor health outcomes.
Sources:
- Obesity in Older Adults: Effect of Degree of Weight Loss on Cardiovascular Markers and Medications
- Very Low Calorie Diets are Associated with Transient Ventricular Impairment before Reversal of Diastolic Dysfunction in Obesity
- Sustained Cardiac Remodeling After a Short-term Very Low Calorie Diet in Type 2 Diabetes Mellitus