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Prognostic Impact of Obesity, Cardiometabolic Risk Factors, and Vascular Function Markers on Outcomes in Ischemic
Konstantinos Mourouzis1,2, Vasiliki Tsigkou1,3, Gerasimos Siasos1,3,4
1Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Insights
Higher body mass index (BMI) and improved flow-mediated dilation (FMD) are linked to better outcomes in ischemic cardiomyopathy. However, multiple cardiometabolic risk factors worsen prognosis.
Area of Science:
- Cardiology
- Vascular Biology
- Metabolic Syndrome
Background:
- Ischemic cardiomyopathy (ICM) significantly impacts morbidity and mortality.
- Obesity paradoxically correlates with better outcomes in heart failure (HF), contrasting with the adverse effects of clustered cardiometabolic risk factors (CMRFs).
- The interaction between vascular function, obesity, and CMRFs in ICM requires further investigation.
Purpose of the Study:
- To investigate the interplay between vascular function, obesity, and CMRFs in patients with ischemic cardiomyopathy.
- To determine the prognostic value of BMI, vascular function markers (FMD, cf-PWV), and CMRF clustering on major adverse cardiovascular events (MACE).
Main Methods:
- A prospective, single-center cohort study of 560 patients with ICM.
- Baseline assessment included BMI, CMRFs (diabetes mellitus, arterial hypertension, hyperlipidemia), flow-mediated dilation (FMD), and carotid-femoral pulse wave velocity (cf-PWV).
- Major adverse cardiovascular events (MACE) were recorded, and Cox proportional hazards models were used for analysis.
Main Results:
- Obesity was independently associated with a 50% reduced risk of MACE (HR 0.50; 95% CI 0.32-0.981).
- A 1% improvement in FMD corresponded to a 7% reduction in MACE risk (HR 0.93; 95% CI 0.87-0.99).
- Clustering of all three CMRFs predicted increased MACE risk (HR 1.42; 95% CI 1.03-1.95).
Conclusions:
- Higher BMI and enhanced FMD are independent predictors of improved outcomes in ischemic cardiomyopathy.
- The clustering of cardiometabolic risk factors is a significant predictor of adverse cardiovascular events in ICM.
- Vascular stiffness (cf-PWV) was impaired with CMRF clustering but did not predict MACE.
Abstract:
Background/Objectives: Ischemic cardiomyopathy is a major cause of morbidity and mortality. Obesity is paradoxically associated with better outcomes, while clustering of cardiometabolic risk factors (CMRFs)-diabetes mellitus, arterial hypertension, and hyperlipidemia-is associated with worse prognosis in heart failure (HF) patients. The interplay between vascular function, obesity and clustering of CMRFs in ischemic HF is not thoroughly investigated. Methods: In a prospective, single-center cohort study, 560 patients with ischemic cardiomyopathy were followed for a median of 43 months. Baseline BMI, CMRFs and markers of vascular function including flow-mediated dilation (FMD), and carotid-femoral pulse wave velocity (cf-PWV) were assessed. Major adverse cardiovascular events (MACE), including death, myocardial infarction, coronary revascularization, stroke, and hospitalization for heart failure or other cardiovascular causes, were recorded. Cox proportional hazards models and cubic spline analyses evaluated associations and nonlinear relationships. Results: Obesity was independently associated with a 50% lower risk of MACE (HR 0.50; 95% CI 0.32-0.981; p = 0.01) and improvement of FMD by 1% corresponded to a 7% reduction in MACE risk (HR 0.93; 95% CI 0.87-0.99; p = 0.03) after adjusting for multiple confounders. Clustering of all three CMRFs predicted greater MACE risk (HR 1.42; 95% CI 1.03-1.95; p = 0.03). No significant differences in FMD or cf-PWV were observed across BMI groups. cf-PWV values were impaired among patients with all 3 CMRFs but cf-PWV did not predict MACE. Conclusions: Higher BMI and FMD each independently predict improved outcomes in ischemic cardiomyopathy. The clustering of cardiometabolic risk factors is a strong predictor of adverse events.
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