The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data


Padwal, R; McAlister, FA; McMurray, JJV; Cowie, MR; Rich, M; Pocock, S; Swedberg, K; Maggioni, A; Gamble, G; Ariti, C; Earle, N; Whalley, G; Poppe, KK; Doughty, RN; Bayes-Genis, A; Meta-Analysis Global Grp Chronic, H; (2013) The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data. International journal of obesity and related metabolic disorders, 38 (8). pp. 1110-1114. ISSN 0307-0565 DOI: https://doi.org/10.1038/ijo.2013.203

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Abstract

BACKGROUND: In heart failure (HF), obesity, defined as body mass index (BMI) >= 30 kg m(-2), is paradoxically associated with higher survival rates compared with normal-weight patients (the 'obesity paradox'). We sought to determine if the obesity paradox differed by HF subtype (reduced ejection fraction (HF-REF) versus preserved ejection fraction (HF-PEF)). PATIENTS AND METHODS: A sub-analysis of the MAGGIC meta-analysis of patient-level data from 14 HF studies was performed. Subjects were divided into five BMI groups: < 22.5, 22.5-24.9 (referent), 25-29.9, 30-34.9 and >= 35 kg m(-2). Cox proportional hazards models adjusted for age, sex, aetiology (ischaemic or non-ischaemic), hypertension, diabetes and baseline blood pressure, stratified by study, were used to examine the independent association between BMI and 3-year total mortality. Analyses were conducted for the overall group and within HF-REF and HF-PEF groups. RESULTS: BMI data were available for 23 967 subjects (mean age, 66.8 years; 32% women; 46% NYHA Class II; 50% Class III) and 5609 (23%) died by 3 years. Obese patients were younger, more likely to receive cardiovascular (CV) drug treatment, and had higher comorbidity burdens. Compared with BMI levels between 22.5 and 24.9 kg m(-2), the adjusted relative hazards for 3-year mortality in subjects with HF-REF were: hazard ratios (HR)=1.31 (95% confidence interval=1.15-1.50) for BMI < 22.5, 0.85 (0.76-0.96) for BMI 25.0-29.9, 0.64 (0.55-0.74) for BMI 30.0-34.9 and 0.95 (0.78-1.15) for BMI >= 35. Corresponding adjusted HRs for those with HF-PEF were: 1.12 (95% confidence interval=0.80-1.57) for BMI < 22.5, 0.74 (0.56-0.97) for BMI 25.0-29.9, 0.64 (0.46-0.88) for BMI 30.0-34.9 and 0.71 (0.49-1.05) for BMI >= 35. CONCLUSIONS: In patients with chronic HF, the obesity paradox was present in both those with reduced and preserved ventricular systolic function. Mortality in both HF subtypes was U-shaped, with a nadir at 30.0-34.9 kg m(-2).

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
PubMed ID: 24173404
Web of Science ID: 340666900013
URI: http://researchonline.lshtm.ac.uk/id/eprint/1924811

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