High body mass index (BMI) and low cardiorespiratory fitness (CRF) are important modifiable risk factors for heart failure (HF). While the individual contributions of CRF and BMI toward risk for HF are well established, the interrelationship between BMI and CRF in modifying long-term HF risk is more complex and not well understood. In this review, we discuss and summarize the available evidence-base on individual and joint contributions of obesity and low CRF toward HF risk, including the potential mechanisms through which these lifestyle risk factors may lead to HF. We also discuss the role of interventions aimed at intentional loss of weight or CRF improvement as potential HF preventive strategies. Finally, the article also highlights the modifying effects of CRF on survival in relation to the obesity paradox in patients with established HF.
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Body mass index
Cooper Center for Longitudinal Study
Coronary heart disease
Left ventricle or ventricular
Left ventricular hypertrophy
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Conflict of Interest
Ambarish Pandey: None
Jarett D. Berry: None
Carl J. Lavie has received personal fees outside of the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Epidemiology of Heart Failure
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Pandey, A., Berry, J.D. & Lavie, C.J. Cardiometabolic Disease Leading to Heart Failure: Better Fat and Fit Than Lean and Lazy. Curr Heart Fail Rep 12, 302–308 (2015). https://doi.org/10.1007/s11897-015-0265-5
- Heart failure
- Cardiorespiratory fitness
- Physical activity