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(Hypertension. 2008;52:181.)
© 2008 American Heart Association, Inc.

Brief Reviews

Adaptation and Maladaptation of the Heart in Obesity

From the Department of Internal Medicine, Division of Cardiology, University of Texas Medical School at Houston.

Correspondence to Heinrich Taegtmeyer, Department of Internal Medicine, Division of Cardiology, University of Texas Medical School at Houston, 6431 Fannin, MSB 1.246, Houston, TX 77030. E-mail Heinrich.Taegtmeyer@uth.tmc.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Obesity appears to be a major cause of hypertension and associated cardiovascular pathophysiology, including cardiac dysfunction. However, obesity may lead to abnormal cardiac function through mechanisms that are independent of, or that act in concert with, hypertension. One hypothesis of obesity-induced cardiac dysfunction is that an oversupply of substrates leads first to adaptive changes and eventually to contractile dysfunction of the heart. We reason that increased supply of nonesterified fatty acids, together with metabolic dysregulation in obesity, including an inadequate activation of fat oxidation, results in the accumulation of toxic lipid byproducts and subsequent contractile dysfunction. Although the phenomenon may have already been known to Virchow¹ when he described "fatty metamorphosis" of the heart, the concept of cardiac "lipotoxicity" re-emerged only recently with its description in the heart of the obese Zucker diabetic fatty rat.² The concept is, however, still a hypothesis rather than an established physiological principle. In spite of the many investigations performed in rodent models, the mechanism(s) responsible for impaired contractile function of the heart is still obscure, and it is uncertain whether lipid metabolites contribute to "obesity cardiomyopathy" in humans. Our brief review is an attempt to understand the chronic regulatory effects of changes in systemic metabolism on cardiac function. In other words, we discuss current concepts of cardiac adaptation and maladaptation to a deranged metabolic environment.

	Heart Muscle Disease in Human Obesity

 
Changes in cardiovascular function in the setting of clinically severe obesity were first reported in obese volunteers undergoing cardiac catheterization. The patients demonstrated reduced left ventricular (LV) compliance and . . . [Full Text of this Article]

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