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

Padwal, R. et al. (2014) The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data. International Journal of Obesity, 38(8), pp. 1110-1114. (doi: 10.1038/ijo.2013.203) (PMID:24173404)

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)).<p></p> 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.<p></p> 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.<p></p> 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.<p></p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Padwal, R., McAlister, F.A., McMurray, J., Cowie, M.R., Rich, M., Pocock, S., Swedberg, K., Maggioni, A., Gamble, G., Ariti, C., Earle, N., Whalley, G., Poppe, K.K., Doughty, R.N., and Bayes-Genis, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: International Journal of Obesity
• Publisher: Nature Publishing Group
• ISSN: 0307-0565
• ISSN (Online): 1476-5497