Obesity, cardiomyopathy and anabolic hormones

Obesity is associated with hemodynamic alterations that may lead to heart failure (HF), through the development of cardiac structural abnormalities and impairment of ventricular function. Obesity-related neurohormonal and metabolic disturbances may predispose to HF, even in the absence of comorbidities. Excess adipose tissue and in particular visceral adiposity contributes to the altered production of a number of anabolic hormones also involved in the regulation of the cardiac function. The aim of the present study was to evaluate cardiac morphology and function by echocardiography and the relationships between echocardiographic parameters, BMI and hormonal status in a population of obese patients. 1821 patients (mean age 46.94±13.62 yrs, 1331 females and 490 males) were studied. 157 were normal weight (BMI 22.14±1.83), 247 overweight (BMI 27.76±1.45), and 1417 obese (BMI 39.39±6.88). Anthropometric data, blood pressure, lipid and glycemic parameters and a complete hormonal status were recorded. Two-dimensional echocardiography and carotid intima/media thickness measurement were performed. Total testosterone in males and SHBG in both sexes were significantly and inversely correlated with epicardial fat thickness (EFT) (r=−0.33 and r=−0.44, P<0.001). Circulating levels of DHEAS were positively related with E/A ratio (r=0.26 P<0.001) and inversely with left ventricular mass index (LVMi) (r=−0.20 P<0.01) and carotid intima-media thickness (cIMT) (r=−0.24 P<0.005). Urinary free cortisol was positively related with EFT (r=0.22 P<0.001). Circulating IGF1 levels were positively related to E/A ratio (r=0.27 P<0.001) and negatively correlated with EFT (r-0.14 P<0.001), LVMi (r=−0.16 P<0.001), end diastolic left ventricular diameter (r=−0.16 P<0.001), cIMT (r=−0.25 P<0.001), and left atrial diameter (r=−0.14 P<0.001). All the echocardiographic and hormonal parameters evaluated showed significant correlation with the degree of weight excess and the duration of obesity (P<0.001). In conclusion, cardiac function and morphology associate with weight excess, duration of obesity and anabolic hormones deficiencies.