Body Mass Index and Mortality in Acutely Decompensated Heart Failure Across the World: A Global Obesity Paradox

详细信息    查看全文

• 作者：Ravi Shah ; MD^&lowast ; ; Etienne Gayat ; MD ; MS^&dagger ; ; James L. Januzzi Jr. ; MD^&lowast ; ; ^{jjanuzzi@partners.org" class="auth_mail} ; Naoki Sato ; MD ; PhD^&Dagger ; ; Alain Cohen-Solal ; MD ; PhD^§ ; ; Salvatore diSomma ; MD^鈥?/sup> ; Enrique Fairman ; MD^¶ ; ; Veli-Pekka Harjola ; MD^# ; Shiro Ishihara ; MD^&lowast ; &lowast ; ; Johan Lassus ; MD ; PhD^&dagger ; &dagger ; ; Aldo Maggioni ; MD^&Dagger ; &Dagger ; ; Marco Metra ; MD ; PhD^§ ; § ; ; Christian Mueller ; MD^{鈥栤€?/sup>} ; Thomas Mueller ; MD^¶ ; ¶ ; ; Jiri Parenica ; MD ; MS^## ; Domingo Pascual-Figal ; MD ; PhD^&lowast ; &lowast ; &lowast ; ; William Frank Peacock ; MD^&dagger ; &dagger ; &dagger ; ; Jindrich Spinar ; MD ; PhD^## ; Roland van Kimmenade ; MD ; PhD^&Dagger ; &Dagger ; &Dagger ; ; Alexandre Mebazaa ; MD^&dagger ; &dagger ; ; for the GREAT (Global Research on Acute Conditions Team) Network
• 关键词：heart failure ; obesity ; obesity paradox
• 刊名：Journal of the American College of Cardiology
• 出版年：4 March, 2014
• 年：2014
• 卷：63
• 期：8
• 页码：778-785
• 全文大小：665 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

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聽<聽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聽< 0.001). Notably, the 鈥減rotective鈥?association of BMI with mortality was confined to persons with older age (>75 years; hazard ratio [HR]: 0.82; p聽= 0.006), decreased cardiac function (ejection fraction聽<50%; HR: 0.85; p聽< 0.001), no diabetes (HR: 0.86; p聽< 0.001), and de novo HF (HR: 0.89; p聽= 0.004).

Conclusions

A lower BMI is associated with age, disease severity, and a higher risk of death in acute decompensated HF. The 鈥渙besity paradox鈥?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.