The effectiveness of weight-loss drugs in heart failure (HF) with preserved ejection fraction (HFpEF) highlights the link between obesity (adipose tissue) and HF (the heart). Recent guidelines incorporating the waist:height ratio for diagnosing and treating obesity reflect the growing recognition of the significance of visceral adiposity. However, its unique impact on HFpEF and their complex relationship remain underexplored. With limited treatment options for obesity-related HFpEF, novel disease-modifying treatments are urgently needed. Here, we clarify the relationship between visceral obesity and HFpEF, introducing the concept of the visceral adipose tissue-heart axis to explore its mechanisms and therapeutic potential. We also discuss promising strategies targeting visceral obesity in HFpEF and propose directions for future research.

Beijing Anzhen Hospital Capital Medical University Key Laboratory of the Ministry of Education for Cardiovascular Remodeling Related Diseases Beijing Collaborative Innovative Research Center for Cardiovascular Diseases Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

The Innovation Center of Cardiometabolic Disease Guangdong Medical University Dongguan 523808 China; School of Pharmaceutical Sciences Wenzhou Medical University Wenzhou 325035 China

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