Rethinking HFpEF: Targeting obesity as the root cause

Prof Andrew Sindone AM

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Prof Andrew Sindone AM

Cardiologist; Director of the Heart Failure Unit and Department of Cardiac Rehabilitation, Concord Hospital; Head, Department of Cardiology, Ryde Hospital

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New Heart Foundation consensus statement recommends considering semaglutide or tirzepatide for improved quality of life and symptoms in people with HFpEF & obesity. Here’s an overview of the research to date…

Rising obesity rates1 are contributing to an ever-growing burden of chronic disease. Beyond its well-known associations with diabetes and hypertension, obesity has now emerged as a leading driver of heart failure with preserved ejection fraction (HFpEF), a form of heart failure that has long been considered difficult to diagnose and even harder to treat.

Recent years have brought a surge in our understanding of the complex interplay between adiposity, cardiovascular mechanics, and systemic inflammation. Alongside these insights, new therapeutic strategies, including incretin-based agents, are reshaping the management of patients with obesity-related HFpEF.

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References

  1. Australian Institute of Health and Welfare. Overweight and obesity. Available at: https://www.aihw.gov.au/reports/overweight-obesity/overweight-and-obesity/contents/summary [accessed January 2026].
  2. Koskinas KC, et al. Eur Heart J. 2024;45(38):4063–4098.
  3. Khan SS, et al. JAMA Cardiol. 2018;3(4):280-287.
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  5. Lopez-Candales A, et al. Cardiovasc Ther. 2023;2023:1552826.
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  17. van Veldhuisen, SL et al. Eur Heart J. 2022;43(20):1955–1969.
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  19. Kosiborod, MN et al. 2024;404(10456):949–961.
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  21. Andraos J, et al. Rev Endocr Metab Disord. 2023;24(6):1089–1101.
  22. National Heart Foundation of Australia, Obesity and cardiovascular disease: A clinical consensus statement, 2026.
  23. Chopra V, et al. Heart Lung Circ. 2025;34(7):e55-e82.

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Prof Andrew Sindone AM

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Prof Andrew Sindone AM

Cardiologist; Director of the Heart Failure Unit and Department of Cardiac Rehabilitation, Concord Hospital; Head, Department of Cardiology, Ryde Hospital

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