Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox

Butt, J. H. et al. (2023) Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox. European Heart Journal, (doi: 10.1093/eurheartj/ehad083) (Early Online Publication)

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Aims: Although body mass index (BMI) is the most commonly used anthropometric measure, newer indices such as the waist-to-height ratio, better reflect the location and amount of ectopic fat, as well as the weight of the skeleton, and may be more useful. Methods and results: The prognostic value of several newer anthropometric indices was compared with that of BMI in patients with heart failure (HF) and reduced ejection fraction (HFrEF) enrolled in prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure. The primary outcome was HF hospitalization or cardiovascular death. The association between anthropometric indices and outcomes were comprehensively adjusted for other prognostic variables, including natriuretic peptides. An ‘obesity-survival paradox’ related to lower mortality risk in those with BMI ≥25 kg/m2 (compared with normal weight) was identified but this was eliminated by adjustment for other prognostic variables. This paradox was less evident for waist-to-height ratio (as an exemplar of indices not incorporating weight) and eliminated by adjustment: the adjusted hazard ratio (aHR) for all-cause mortality, for quintile 5 vs. quintile 1, was 1.10 [95% confidence interval (CI) 0.87–1.39]. However, both BMI and waist-to-height ratio showed that greater adiposity was associated with a higher risk of the primary outcome and HF hospitalization; this was more evident for waist-to-height ratio and persisted after adjustment e.g. the aHR for HF hospitalization for quintile 5 vs. quintile 1 of waist-to-height ratio was 1.39 (95% CI 1.06–1.81). Conclusion: In patients with HFrEF, alternative anthropometric measurements showed no evidence for an ‘obesity-survival paradox’. Newer indices that do not incorporate weight showed that greater adiposity was clearly associated with a higher risk of HF hospitalization.

Item Type:Articles
Additional Information:The PARADIGM-HF trial was funded by Novartis. Profs. McMurray and Jhund are supported by British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217.
Status:Early Online Publication
Glasgow Author(s) Enlighten ID:Butt, Mr Jawad and Sattar, Professor Naveed and Jhund, Professor Pardeep and McMurray, Professor John and Kober, Professor Lars and Petrie, Professor Mark
Authors: Butt, J. H., Petrie, M. C., Jhund, P. S., Sattar, N., Desai, A. S., Køber, L., Rouleau, J. L., Swedberg, K., Zile, M. R., Solomon, S. D., Packer, M., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN (Online):1522-9645
Published Online:22 March 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in European Heart Journal 2023
Publisher Policy:Reproduced in accordance with the publisher copyright policy
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science