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The relationship between obesity and mortality in patients with heart failure
T B Horwich1, G C Fonarow, M A Hamilton
1Department of Medicine, University of California at Los Angeles Medical Center, Los Angeles, California, USA.
Insights
Obesity does not increase mortality in advanced heart failure (HF) patients. In fact, higher body mass index (BMI) may be linked to a better prognosis, challenging weight loss goals in this population.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Clinical Medicine
Background:
- Obesity is a known risk factor for developing heart failure (HF).
- The prognostic impact of obesity in patients with established HF remains understudied.
Purpose of the Study:
- To investigate the association between obesity and prognosis in patients with advanced heart failure (HF).
Main Methods:
- A cohort of 1,203 advanced heart failure (HF) patients was analyzed.
- Patients were categorized by body mass index (BMI): underweight (<20.7), recommended (20.7-27.7), overweight (27.8-31), and obese (>31).
- One-year survival rates were compared across BMI groups.
Main Results:
- Obese and overweight groups had higher rates of hypertension, diabetes, and elevated cholesterol.
- Despite these comorbidities, all four BMI groups exhibited similar survival rates.
- Higher BMI was not a risk factor for mortality; a trend toward improved survival was observed.
Conclusions:
- Obesity is not linked to increased mortality in advanced heart failure (HF) patients.
- A higher body mass index (BMI) may be associated with a more favorable prognosis in HF.
- Further research is needed to determine if weight loss is a beneficial therapeutic goal for medically optimized HF patients.
Objectives:
The study aimed to evaluate the role of obesity in the prognosis of patients with heart failure (HF).
Background:
Previous reports link obesity to the development of HF. However, the impact of obesity in patients with established HF has not been studied.
Methods:
We analyzed 1,203 patients with advanced HF followed in a comprehensive HF management program. The patients were subclassified into categories of body mass index (BMI) defined as: underweight BMI <20.7 (n = 164), recommended BMI 20.7 to 27.7 (n = 692), overweight BMI 27.8 to 31 (n = 168) and obese BMI >31 (n = 179). This sample size allows the detection of small effects (0.02), with a power of 0.80 and an alpha level of 0.05 for comparing one-year survival between BMI groups.
Results:
The four BMI groups had similar profiles in terms of ejection fraction (mean 0.22), sodium, creatinine and smoking. The obese and overweight groups had significantly higher rates of hypertension and diabetes, as well as higher levels of cholesterol, triglycerides and low density lipoprotein cholesterol. The four BMI groups had similar survival rates. Ejection fraction, HF etiology and angiotensin-converting enzyme inhibitor use predicted survival on univariate analysis (p < 0.01), although BMI did not. On multivariate analysis, cardiopulmonary exercise tests, pulmonary capillary wedge pressure and serum sodium were strong predictors of survival (p < 0.05). Higher BMI was not a risk factor for increased mortality, but was associated with a trend toward improved survival.
Conclusions:
In a large cohort of patients with advanced HF of multiple etiologies, obesity is not associated with increased mortality and may confer a more favorable prognosis. Further studies need to delineate whether weight loss promotion in medically optimized patients with HF is a worthwhile therapeutic goal.
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