期刊
AMERICAN HEART JOURNAL
卷 159, 期 1, 页码 75-80出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.ahj.2009.10.026
关键词
-
资金
- Chronic Heart Failure Quality Enhancement Research Initiative of the Veterans Administration
Background Studies document better survival in heart failure patients with decreased left ventricular ejection fraction (EF) and higher body mass index (BMI; kg/m(2)) compared to those with a lower BMI. However, it is unknown if this obesity paradox applies to heart failure patients with preserved EF or if it extends to the very obese (BMI >35). Methods We determined all-cause mortality for 1,236 consecutive patients with a prior diagnosis of heart failure and a preserved EF (>= 50%). Results Obesity (BMI>30) was noted in 542 patients (44%). The mean age was 71 +/- 12 years, but this varied depending on BMI. One-year all-cause mortality decreased with increasing BMI, except at BMI >45 where mortality began to increase (55% if BMI <20, 38% if BMI 20-25, 26% if BMI 26-30, 25% if BMI 31-35, 17% if BMI 36-40, 18% if BMI 41-45, and 25% if BMI >45, P<.001). After adjustment for patient age, history, medications, and laboratory and echocardiographic parameters, the hazard ratios for total mortality (relative to BMI 26-30) were 1.68 (95% CI, 1.04-2.69) for BMI <20, 1.25 (95% CI, 0.92-1.68) for BMI 20 to 25, 0.99 (95% CI, 0.71-1.36) for BMI 31-35, 0.58 (95% CI, 0.35-0.97) for BMI 36 to 40, 0.79 (95% CI, 0.44-1.4) for BMI 41 to 45, and 1.38 (95% CI 0.74-2.6) for BMI >45 (P<.0001). Conclusions Low BMI is associated with increased mortality in patients with heart failure and preserved systolic function. However, with a BMI of >45, mortality increased, raising the possibility of a U-shaped relationship between BMI and survival. (Am Heart J 2010; 159: 75-80.)
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