The obesity paradox in heart failure: Is etiology a key factor?

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• 作者：Elisabet Zamora ; ^{e.zamora@telefonica.net} ; Josep Lupó ; n ; Marta de Antonio ; Agustí ; n Urrutia ; Ramon Coll ; Crisanto Dí ; ez ; Salvador Altimir ; Antoni Bayé ; s-Gení ; s
• 关键词：Heart failure ; Body mass index ; Etiology ; Mortality ; Ischemic heart disease
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：1 July, 2013
• 年：2013
• 卷：166
• 期：3
• 页码：601-605
• 全文大小：342 K

文摘

Background

Obesity is paradoxically associated with survival in patients with heart failure (HF). Our objective was to assess whether the relationship between body mass index (BMI) and long-term survival is associated with HF etiology (ischemic vs. non-ischemic) in a cohort of ambulatory HF patients.

Methods

BMI and survival status after a median follow-up of 6.1 years (IQR 2.2-7.8) were available for 504 patients (73 % men; median age 68 years [IQR 58-74]). Fifty-nine percent of patients had ischemic etiology. Median left ventricular ejection fraction (LVEF) was 30 % (IQR 23-39.7 % ). Most patients were in NYHA functional class II (51 % ) or III (42 % ). Patients were divided into four groups according to BMI: low weight (BMI < 20.5 kg/m²), normal weight (BMI 20.5 to < 25.5 kg/m²), overweight (BMI 25.5 to < 30 kg/m²), and obese (BMI ¡Ý 30 kg/m²).

Results

Mortality differed significantly across the BMI strata in non-ischemic patients (log-rank p < 0.0001) but not in ischemic patients. Using normal weight patients as a reference, hazard ratios for low weight, overweight, and obese patients were 2.08 (1.16-3.75, p = 0.014), 0.88 (0.54-1.43, p = 0.60), and 0.49 (0.28-0.86, p = 0.01), respectively, for non-ischemic patients and 1.19 (0.48-2.97, p = 0.71), 0.88 (0.61-1.27, p = 0.48), and 0.96 (0.66-1.41, p = 0.85), respectively, for ischemic patients. After adjusting for age, sex, NYHA functional class, LVEF, co-morbidities, and treatment, BMI remained an independent predictor of survival in non-ischemic patients.

Conclusion

Over long-term follow-up of ischemic and non-ischemic HF, the obesity paradox was only observed in patients with non-ischemic HF.