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Adipositas und kardiale Kachexie bei chronischer Herzinsuffizienz

Obesity and cardiac cachexia in chronic heart failure

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Zusammenfassung

Sowohl das Phänomen „obesity paradox“ als auch insbesondere die kardiale Kachexie bei Herzinsuffizienz sind bis heute Gegenstand intensiver Forschung hinsichtlich zugrunde liegender Pathomechanismen und möglicher Therapieansätze. Die Adipositas ist ein etablierter Risikofaktor in der Entwicklung kardiovaskulärer Erkrankungen und ist mit einer erhöhten Mortalität assoziiert. Im Gegensatz dazu scheint Übergewicht bei herzinsuffizienten Patienten im Vergleich zu Normalgewichtigen mit einem Überlebensvorteil einherzugehen – ein Phänomen, welches auch als „obesity paradox“ bekannt ist. In den letzten Jahren ist die Kachexie als Komorbidität chronischer Erkrankungen wie Herzinsuffizienz, COPD, Karzinomen oder Niereninsuffizienz in den Fokus wissenschaftlichen Interesses gerückt. Da Kachexie mit einer deutlich ungünstigeren Prognose assoziiert ist, sind eine frühe Diagnose und gut wirksame Behandlungskonzepte von enormer Wichtigkeit. Ziel dieses Reviews ist es, einen aktuellen Überblick über die Pathomechanismen und erfolgversprechende Behandlungsmöglichkeiten zu geben.

Abstract

Obesity as well as cardiac cachexia in heart failure patients are not fully understood and therefore of high scientific interest. Obesity as a common risk factor for cardiovascular disease is associated with a high mortality. In contrast obesity in patients suffering from chronic heart failure seems to be accompanied with a favorable outcome in contrast to people with normal weight, known as the obesity paradox. In the last decade there has been growing interest in cachexia, which is common in advanced stages of chronic diseases, such as heart failure, chronic obstructive pulmonary disease (COPD), cancer and renal failure and is associated with a poor prognosis. Until now cachexia has been underdiagnosed and undertreated. This review discusses the complex underlying pathomechanisms as well as potential therapeutic approaches.

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Interessenkonflikt. J. Altenberger und M. Clauser geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Clauser, M., Altenberger, J. Adipositas und kardiale Kachexie bei chronischer Herzinsuffizienz. Herz 38, 610–617 (2013). https://doi.org/10.1007/s00059-013-3885-0

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