TY - JOUR
T1 - Re-appraisal of the obesity paradox in heart failure
T2 - a meta-analysis of individual data
AU - Marcks, Nick
AU - Aimo, Alberto
AU - Januzzi, James L.
AU - Vergaro, Giuseppe
AU - Clerico, Aldo
AU - Latini, Roberto
AU - Meessen, Jennifer
AU - Anand, Inder S.
AU - Cohn, Jay N.
AU - Gravning, Jørgen
AU - Ueland, Thor
AU - Bayes-Genis, Antoni
AU - Lupón, Josep
AU - de Boer, Rudolf A.
AU - Yoshihisa, Akiomi
AU - Takeishi, Yasuchika
AU - Egstrup, Michael
AU - Gustafsson, Ida
AU - Gaggin, Hanna K.
AU - Eggers, Kai M.
AU - Huber, Kurt
AU - Tentzeris, Ioannis
AU - Ripoli, Andrea
AU - Passino, Claudio
AU - Sanders-van Wijk, Sandra
AU - Emdin, Michele
AU - Brunner-La Rocca, Hans Peter
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2021/3/11
Y1 - 2021/3/11
N2 - Background: Higher body mass index (BMI) is associated with better outcome compared with normal weight in patients with HF and other chronic diseases. It remains uncertain whether the apparent protective role of obesity relates to the absence of comorbidities. Therefore, we investigated the effect of BMI on outcome in younger patients without co-morbidities as compared to older patients with co-morbidities in a large heart failure (HF) population. Methods: In an individual patient data analysis from pooled cohorts, 5,819 patients with chronic HF and data available on BMI, co-morbidities and outcome were analysed. Patients were divided into four groups based on BMI (i.e. ≤ 18.5 kg/m2, 18.5–25.0 kg/m2; 25.0–30.0 kg/m2; 30.0 kg/m2). Primary endpoints included all-cause mortality and HF hospitalization-free survival. Results: Mean age was 65 ± 12 years, with a majority of males (78%), ischaemic HF and HF with reduced ejection fraction. Frequency of all-cause mortality or HF hospitalization was significantly worse in the lowest two BMI groups as compared to the other two groups; however, this effect was only seen in patients older than 75 years or having at least one relevant co-morbidity, and not in younger patients with HF only. After including medications and N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin concentrations into the model, the prognostic impact of BMI was largely absent even in the elderly group with co-morbidity. Conclusions: The present study suggests that obesity is a marker of less advanced disease, but does not have an independent protective effect in patients with chronic HF. Graphic abstract: Categories of BMI are only predictive of poor outcome in patients aged > 75 years or with at least one co-morbidity (bottom), but not in those aged < 75 years without co-morbidities (top). The prognostic effect largely disappears in multivariable analyses even for the former group. These findings question the protective effect of obesity in chronic heart failure (HF). [Figure not available: see fulltext.].
AB - Background: Higher body mass index (BMI) is associated with better outcome compared with normal weight in patients with HF and other chronic diseases. It remains uncertain whether the apparent protective role of obesity relates to the absence of comorbidities. Therefore, we investigated the effect of BMI on outcome in younger patients without co-morbidities as compared to older patients with co-morbidities in a large heart failure (HF) population. Methods: In an individual patient data analysis from pooled cohorts, 5,819 patients with chronic HF and data available on BMI, co-morbidities and outcome were analysed. Patients were divided into four groups based on BMI (i.e. ≤ 18.5 kg/m2, 18.5–25.0 kg/m2; 25.0–30.0 kg/m2; 30.0 kg/m2). Primary endpoints included all-cause mortality and HF hospitalization-free survival. Results: Mean age was 65 ± 12 years, with a majority of males (78%), ischaemic HF and HF with reduced ejection fraction. Frequency of all-cause mortality or HF hospitalization was significantly worse in the lowest two BMI groups as compared to the other two groups; however, this effect was only seen in patients older than 75 years or having at least one relevant co-morbidity, and not in younger patients with HF only. After including medications and N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin concentrations into the model, the prognostic impact of BMI was largely absent even in the elderly group with co-morbidity. Conclusions: The present study suggests that obesity is a marker of less advanced disease, but does not have an independent protective effect in patients with chronic HF. Graphic abstract: Categories of BMI are only predictive of poor outcome in patients aged > 75 years or with at least one co-morbidity (bottom), but not in those aged < 75 years without co-morbidities (top). The prognostic effect largely disappears in multivariable analyses even for the former group. These findings question the protective effect of obesity in chronic heart failure (HF). [Figure not available: see fulltext.].
UR - http://www.scopus.com/inward/record.url?scp=85102513230&partnerID=8YFLogxK
U2 - 10.1007/s00392-021-01822-1
DO - 10.1007/s00392-021-01822-1
M3 - Article
C2 - 33704552
AN - SCOPUS:85102513230
SN - 1861-0684
VL - 110
SP - 1280
EP - 1291
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
IS - 8
ER -
