Associations between metabolic overweight/obesity phenotypes and mortality risk among patients with chronic heart
You Zhou1, Yingli Xie2, Jingjing Dong2
1School of Medicine, Nankai University, Tianjin, China.
Insights
Metabolic syndrome increases heart failure death risk in men and elderly women, while overweight/obesity is protective in younger women. These metabolic factors interact differently with chronic heart failure prognosis based on sex and age.
Area of Science:
- Cardiology
- Metabolic Disorders
- Obesity Research
Background:
- Metabolic disorders and obesity are common in chronic heart failure (CHF).
- The interactive effects of these conditions on CHF prognosis, considering age and sex, are not well understood.
Purpose of the Study:
- To investigate the combined impact of metabolic syndrome and body mass index (BMI) on the prognosis of patients with CHF.
- To explore whether age and sex influence the relationship between metabolic status, BMI, and heart failure outcomes.
Main Methods:
- 4,955 CHF patients were classified into four phenotypes: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obese (MHO), and metabolically unhealthy overweight/obese (MUO).
- Metabolic status was determined by metabolic syndrome (MetS) presence, and BMI categories were normal weight (<24 kg/m²), overweight/obese (≥24 kg/m²).
- All-cause and cardiovascular (CV) death incidence were recorded and analyzed using Cox proportional risk models.
Main Results:
- Compared to MHNW, MUNW and MUO phenotypes showed increased all-cause death risk (aHR 1.66 and 1.42, respectively).
- The MHO phenotype demonstrated a reduced risk of all-cause death (aHR 0.61).
- These associations were primarily observed in males and elderly females (≥60 years); however, in nonelderly females (<60 years), overweight/obesity conferred protection regardless of metabolic status.
Conclusions:
- In male and elderly female CHF patients, metabolic syndrome's adverse effects overshadowed overweight/obesity benefits.
- In nonelderly females, overweight/obesity provided significant protection against adverse CHF outcomes, outweighing metabolic syndrome's impact.
- The interplay between metabolic health, weight status, and CHF prognosis is sex- and age-dependent.
Background:
Metabolic disorders and overweight or obesity are highly prevalent and intricately linked in patients with chronic heart failure (CHF). However, it remains unclear whether there is an interactive effect between these conditions and the prognosis of heart failure, and whether such an interaction is influenced by stratification based on age and sex.
Methods:
A total of 4,955 patients with CHF were enrolled in this study. Metabolic status was assessed according to the presence or absence of metabolic syndrome (MetS). BMI categories included normal weight and overweight or obesity (BMI < 24, ≥ 24 kg/m2). Patients were divided into four phenotypes according to their metabolic status and BMI: metabolically healthy with normal weight (MHNW), metabolically unhealthy with normal weight (MUNW), metabolically healthy with overweight or obesity (MHO), and metabolically unhealthy with overweight or obesity (MUO). The incidence of primary outcomes, including all-cause and cardiovascular (CV) death, was recorded.
Results:
During a mean follow-up of 3.14 years, a total of 1,388 (28.0%) all-cause deaths and 815 (16.4%) CV deaths were documented. Compared to patients with the MHNW phenotype, those with the MUNW (adjusted hazard ratio [aHR], 1.66; 95% confidence interval [CI], 1.38-2.00) or MUO (aHR, 1.42 [95% CI, 1.24-1.63]) phenotypes had a greater risk of all-cause death, and those with the MHO phenotype (aHR, 0.61 [95% CI, 0.51-0.72]) had a lower risk of all-cause death. Moreover, the above phenomenon existed mainly among males and elderly females (aged ≥ 60 years). In nonelderly females (aged < 60 years), the detrimental effects of MetS were lower (aHR, 1.05 [95% CI, 0.63-1.75] among MUNW group and aHR, 0.52 [95% CI, 0.34-0.80] among MUO group), whereas the protective effects of having overweight or obesity persisted irrespective of metabolic status (aHR, 0.43 [95% CI, 0.26-0.69] among MHO group and aHR, 0.52 [95% CI, 0.34-0.80] among MUO group). Similar results were obtained in the Cox proportional risk analysis of the metabolic overweight/obesity phenotypes and CV death.
Conclusions:
In male and elderly female patients with CHF, the detrimental effects of MetS outweighed the protective benefits of having overweight or obesity. Conversely, in nonelderly females, the protective effects of having overweight or obesity were significantly greater than the adverse impacts of MetS.
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