Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose–response meta-analysis

Zhang, J., Begley, A., Jackson, R., Harrison, M., Pellicori, P. , Clark, A. L. and Cleland, J. G.F. (2019) Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose–response meta-analysis. Clinical Research in Cardiology, 108(2), pp. 119-132. (doi: 10.1007/s00392-018-1302-7) (PMID:29951802)

Abstract

Background: For patients with heart failure, there is an inverse relation between body mass index (BMI) and mortality, sometimes called the obesity-paradox. However, the relationship might be either U- or J-shaped and might differ between patients with reduced (HFrEF) or preserved left ventricular ejection fraction (HFpEF). We sought to investigate this further in a dose–response meta-analysis of published studies. Methods: PubMed and Embase from June 1980 to April 2017 were searched for prospective cohort studies evaluating associations between BMI and all-cause mortality in patients with HFrEF (LVEF < 40%) or HFpEF (LVEF ≥ 50%). Summary estimated effect sizes were obtained by using a random-effects model. Potential non-linear relationships were evaluated by using random-effects restricted cubic spline models. Results: Ten studies were identified that included 96,424 patients of whom 59,263 had HFpEF (mean age 68 years of whom 38% were women) and 37,161 had HFrEF (mean age 60 years of whom 17% were women). For patients with HFpEF, the summary hazard ratio (HR) for all-cause mortality was: 0.93 (95% CI 0.89–0.97) per 5 units increase in BMI (I2 = 75.8%, p for heterogeneity = 0.01 and Begg’s test, p = 1.0, Egger’s test, p = 0.29) but the association was U-shaped (p for non-linearity < 0.01) with the nadir of risk at a BMI of 32–33 kg/m2. For patients with HFrEF, the summary HR for all-cause mortality was: 0.96 (95% CI 0.92–0.99) (I2 = 95%, p for heterogeneity < 0.001 and Begg’s test, p = 0.45, Egger’s test, p = 0.01). The relationship was also U-shaped (p < 0.01), although ‘flatter’ than for HFpEF, with the nadir at a BMI of 33 kg/m2. Conclusions: For patients with heart failure, the relation between BMI and mortality is U-shaped with a similar nadir of risk for HFpEF and HFrEF at a BMI of 32–33 kg/m2. Whether interventions that alter weight in either direction can alter risk is unknown.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John and Pellicori, Dr Pierpaolo
• Authors: Zhang, J., Begley, A., Jackson, R., Harrison, M., Pellicori, P., Clark, A. L., and Cleland, J. G.F.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Clinical Research in Cardiology
• Publisher: Springer
• ISSN: 1861-0684
• ISSN (Online): 1861-0692
• Published Online: 27 June 2018
• Copyright Holders: Copyright © 2018 Springer-Verlag GmbH Germany, part of Springer Nature
• First Published: First published in Clinical Research in Cardiology 108:119-132
• Publisher Policy: Reproduced in accordance with the publisher copyright policy