Crossroads between Estrogen Loss, Obesity, and Heart Failure with Preserved Ejection Fraction

The prevalence of obesity and heart failure with preserved ejection fraction (HFpEF) increases significantly in postmenopausal women. Although obesity is a risk factor for left ventricular diastolic dysfunction (LVDD), the mechanisms that link the cessation of ovarian hormone production, and particularly estrogens, to the development of obesity, LVDD, and HFpEF in aging females are unclear. Clinical, and epidemiologic studies show that postmenopausal women with abdominal obesity (defined by waist circumference) are at greater risk for developing HFpEF than men or women without abdominal obesity. The study presents a review of clinical data that support a mechanistic link between estrogen loss plus obesity and left ventricular remodeling with LVDD. It also seeks to discuss potential cell and molecular mechanisms for estrogen-mediated protection against adverse adipocyte cell types, tissue depots, function, and metabolism that may contribute to LVDD and HFpEF.

Estrogens; Obesity; Heart Failure; Stroke Volume; Menopause; Adiposity; Overweight; Echocardiography/methods; Body Mass Index

Authorship

Allan Kardec Nogueira de Alencar

Faculdade de Medicina de Petrópolis, Petrópolis, RJ - BrazilFaculdade de Medicina de Petrópolis, Petrópolis, RJ - BrazilBrazilBrazilFaculdade de Medicina de Petrópolis, Petrópolis, RJ - Brazil

https://orcid.org/0000-0002-3072-6270

Hao Wang

Wake Forest School of Medicine - Departments of Anesthesiology, Winston-Salem, North Carolina – United States of AmericaWake Forest School of Medicine - Departments of Anesthesiology, Winston-Salem, North Carolina – United States of AmericaUnited States of AmericaUnited States of AmericaWake Forest School of Medicine - Departments of Anesthesiology, Winston-Salem, North Carolina – United States of America

Wake Forest School of Medicine - Internal Medicine-Section of Molecular Medicine, Winston-Salem, North Carolina - United States of AmericaWake Forest School of Medicine - Internal Medicine-Section of Molecular Medicine, Winston-Salem, North Carolina - United States of AmericaUnited States of AmericaUnited States of AmericaWake Forest School of Medicine - Internal Medicine-Section of Molecular Medicine, Winston-Salem, North Carolina - United States of America

https://orcid.org/0000-0003-1537-661X

Gláucia Maria Moraes de Oliveira

Universidade Federal do Rio de Janeiro - Departamento de Clínica Médica, Faculdade de Medicina, Rio de Janeiro, RJ - BrazilUniversidade Federal do Rio de Janeiro - Departamento de Clínica Médica, Faculdade de Medicina, Rio de Janeiro, RJ - BrazilBrazilBrazilUniversidade Federal do Rio de Janeiro - Departamento de Clínica Médica, Faculdade de Medicina, Rio de Janeiro, RJ - Brazil

https://orcid.org/0000-0002-0737-6188

Xuming Sun

Gisele Zapata-Sudo

Universidade Federal do Rio de Janeiro - Instituto de Ciências Biomédicas, Rio de Janeiro, RJ - BrazilUniversidade Federal do Rio de Janeiro - Instituto de Ciências Biomédicas, Rio de Janeiro, RJ - BrazilBrazilBrazilUniversidade Federal do Rio de Janeiro - Instituto de Ciências Biomédicas, Rio de Janeiro, RJ - Brazil

Universidade Federal do Rio de Janeiro - Instituto de Cardiologia Edson Saad, Faculdade de Medicina, Rio de Janeiro, RJ - BrazilUniversidade Federal do Rio de Janeiro - Instituto de Cardiologia Edson Saad, Faculdade de Medicina, Rio de Janeiro, RJ - BrazilBrazilBrazilUniversidade Federal do Rio de Janeiro - Instituto de Cardiologia Edson Saad, Faculdade de Medicina, Rio de Janeiro, RJ - Brazil

https://orcid.org/0000-0002-9066-5027

Leanne Groban

Mailing Address: Allan Kardec Nogueira de Alencar • Faculdade de Medicina de Petrópolis, School Clinic, Av. Barão do Rio Branco, Centro. Postal Code 25680-120, Petrópolis, RJ, Brazil. E-mail: allankdc@gmail.com

Author Contributions

Conception and design of the research: Alencar AKN, Wang H, Sun X, Groban L; Acquisition of dat and Writing of the manuscript: Alencar AKN, Wang H, Oliveira GMM, Sun X, Groban L; Analysis and interpretation of the data: Alencar AKN, Wang H, Oliveira GMM, Sun X, Zapata-Sudo G, Groban L; Obtaining financing: Alencar AKN, Zapata-Sudo G, Groban L; Critical revision of the manuscript for intellectual content: Alencar AKN, Oliveira GMM, Groban L.

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

SCIMAGO INSTITUTIONS RANKINGS

Faculdade de Medicina de Petrópolis, Petrópolis, RJ - BrazilFaculdade de Medicina de Petrópolis, Petrópolis, RJ - BrazilBrazilBrazilFaculdade de Medicina de Petrópolis, Petrópolis, RJ - Brazil

Figures

Figures (1)

Thumbnail

Figure 1
– A schematic diagram showing the involvement of estrogen loss and obesity in HFpEF. An expansion and a shift of subcutaneous to visceral fat occurs in women after menopause. Abdominal obesity, defined by increased waist circumference, is a major risk factor for the development of HFpEF, which may involve an uptick in the synthesis and release of adipokines, including TNF-α, IL-6, MCP-1, resistin, leptin, lipocalin-2, and plasminogen activator inhibitor-1. These adipokines play critical roles in cardiac inflammation, oxidative stress, and impaired metabolism. On the other hand, the production of adiponectin from white adipocytes, which exerts beneficial effects on insulin sensitivity and cardiovascular function, is markedly reduced in obese individuals. Abnormalities in adipokines, in addition to estrogen loss, might participate in the development of HFpEF by inducing cardiac inflammation and oxidative stress, and finally leading to concentric cardiac hypertrophy, remodeling, stiffness, and diastolic dysfunction. HFpEF, heart failure with preserved ejection fraction; TNF-α, tumor necrosis factor alpha; IL-6, interleukin 6; MCP- 1, monocyte chemoattractant protein; A-FABP, adipocyte fatty acid binding protein .

Figure 1 – A schematic diagram showing the involvement of estrogen loss and obesity in HFpEF. An expansion and a shift of subcutaneous to visceral fat occurs in women after menopause. Abdominal obesity, defined by increased waist circumference, is a major risk factor for the development of HFpEF, which may involve an uptick in the synthesis and release of adipokines, including TNF-α, IL-6, MCP-1, resistin, leptin, lipocalin-2, and plasminogen activator inhibitor-1. These adipokines play critical roles in cardiac inflammation, oxidative stress, and impaired metabolism. On the other hand, the production of adiponectin from white adipocytes, which exerts beneficial effects on insulin sensitivity and cardiovascular function, is markedly reduced in obese individuals. Abnormalities in adipokines, in addition to estrogen loss, might participate in the development of HFpEF by inducing cardiac inflammation and oxidative stress, and finally leading to concentric cardiac hypertrophy, remodeling, stiffness, and diastolic dysfunction. HFpEF, heart failure with preserved ejection fraction; TNF-α, tumor necrosis factor alpha; IL-6, interleukin 6; MCP- 1, monocyte chemoattractant protein; A-FABP, adipocyte fatty acid binding protein .

How to cite

copy

Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
E-mail: revista@cardiol.br

Acompanhe os números deste periódico no seu leitor de RSS

Versão para download de PDF

PDF

Português
Inglês

Versões e tradução automática

Versão original do texto

English
Português

Tradução automática

Google Translator
Microsoft Translator

Como citar

RIS

BIBTEX

Outros formatos de citação e exportação:

SciELO - Scientific Electronic Library Online
Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil
E-mail: scielo@scielo.org

Leia a Declaração de Acesso Aberto

Métricas

Crossroads between Estrogen Loss, Obesity, and Heart Failure with Preserved Ejection Fraction

PlumX

Mensagem

[1] Mailing Address: Allan Kardec Nogueira de Alencar • Faculdade de Medicina de Petrópolis, School Clinic, Av. Barão do Rio Branco, Centro. Postal Code 25680-120, Petrópolis, RJ, Brazil. E-mail: allankdc@gmail.com