Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 63, Issue 8, Pages 778-785Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2013.09.072
Keywords
heart failure; obesity; obesity paradox
Categories
Funding
- Servier
- Roche Diagnostics
- Siemens Diagnostics
- Critical Diagnostics
- Thermo-Fisher Diagnostics
- Alere
- Abbott
- Baxter
- Brahms AG
- Novartis
- Medicines Company
- Eli Lily and Company
Ask authors/readers for more resources
Objectives This study sought to define the relationship between body mass index (BMI) and mortality in heart failure (HF) across the world and to identify specific groups in whom BMI may differentially mediate risk. Background Obesity is associated with incident HF, but it is paradoxically associated with better prognosis during chronic HF. Methods We studied 6,142 patients with acute decompensated HF from 12 prospective observational cohorts followed-up across 4 continents. Primary outcome was all-cause mortality. Cox proportional hazards models and net reclassification index described associations of BMI with all-cause mortality. Results Normal-weight patients (BMI 18.5 to 25 kg/ m2) were older with more advanced HF and lower cardiometabolic risk. Despite worldwide heterogeneity in clinical features across obesity categories, a higher BMI remained associated with decreased 30-day and 1-year mortality (11% decrease at 30 days; 9% decrease at 1 year per 5 kg/ m2; p < 0.05), after adjustment for clinical risk. The BMI obtained at index admission provided effective 1-year risk reclassification beyond current markers of clinical risk (net reclassification index 0.119, p < 0.001). Notably, the protective association of BMI with mortality was confined to persons with older age (> 75 years; hazard ratio [HR]: 0.82; p 0.006), decreased cardiac function (ejection fraction < 50%; HR: 0.85; p < 0.001), no diabetes (HR: 0.86; p < 0.001), and de novo HF (HR: 0.89; p 0.004). Conclusions A lower BMI is associated with age, disease severity, and a higher risk of death in acute decompensated HF. The obesity paradox is confined to older persons, with decreased cardiac function, less cardiometabolic illness, and recent-onset HF, suggesting that aging, HF severity/chronicity, and metabolism may explain the obesity paradox. (c) 2014 by the American College of Cardiology Foundation
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available