TY - JOUR
T1 - Body mass index and mortality in acutely decompensated heart failure across the world
T2 - a global obesity paradox
AU - Shah, Ravi
AU - Gayat, Etienne
AU - Januzzi, James L
AU - Sato, Naoki
AU - Cohen-Solal, Alain
AU - diSomma, Salvatore
AU - Fairman, Enrique
AU - Harjola, Veli-Pekka
AU - Ishihara, Shiro
AU - Lassus, Johan
AU - Maggioni, Aldo
AU - Metra, Marco
AU - Mueller, Christian
AU - Mueller, Thomas
AU - Parenica, Jiri
AU - Pascual-Figal, Domingo
AU - Peacock, William Frank
AU - Spinar, Jindrich
AU - van Kimmenade, Roland
AU - Mebazaa, Alexandre
AU - GREAT (Global Research on Acute Conditions Team) Network
N1 - Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2014/3/4
Y1 - 2014/3/4
N2 - OBJECTIVES: This study sought to define the relationship between body mass index (BMI) and mortality in heart failure (HF) across the world and to identify specific groups in whom BMI may differentially mediate risk.BACKGROUND: Obesity is associated with incident HF, but it is paradoxically associated with better prognosis during chronic HF.METHODS: We studied 6,142 patients with acute decompensated HF from 12 prospective observational cohorts followed-up across 4 continents. Primary outcome was all-cause mortality. Cox proportional hazards models and net reclassification index described associations of BMI with all-cause mortality.RESULTS: Normal-weight patients (BMI 18.5 to 25 kg/m(2)) were older with more advanced HF and lower cardiometabolic risk. Despite worldwide heterogeneity in clinical features across obesity categories, a higher BMI remained associated with decreased 30-day and 1-year mortality (11% decrease at 30 days; 9% decrease at 1 year per 5 kg/m(2); p < 0.05), after adjustment for clinical risk. The BMI obtained at index admission provided effective 1-year risk reclassification beyond current markers of clinical risk (net reclassification index 0.119, p < 0.001). Notably, the "protective" association of BMI with mortality was confined to persons with older age (>75 years; hazard ratio [HR]: 0.82; p = 0.006), decreased cardiac function (ejection fraction <50%; HR: 0.85; p < 0.001), no diabetes (HR: 0.86; p < 0.001), and de novo HF (HR: 0.89; p = 0.004).CONCLUSIONS: A lower BMI is associated with age, disease severity, and a higher risk of death in acute decompensated HF. The "obesity paradox" is confined to older persons, with decreased cardiac function, less cardiometabolic illness, and recent-onset HF, suggesting that aging, HF severity/chronicity, and metabolism may explain the obesity paradox.
AB - OBJECTIVES: This study sought to define the relationship between body mass index (BMI) and mortality in heart failure (HF) across the world and to identify specific groups in whom BMI may differentially mediate risk.BACKGROUND: Obesity is associated with incident HF, but it is paradoxically associated with better prognosis during chronic HF.METHODS: We studied 6,142 patients with acute decompensated HF from 12 prospective observational cohorts followed-up across 4 continents. Primary outcome was all-cause mortality. Cox proportional hazards models and net reclassification index described associations of BMI with all-cause mortality.RESULTS: Normal-weight patients (BMI 18.5 to 25 kg/m(2)) were older with more advanced HF and lower cardiometabolic risk. Despite worldwide heterogeneity in clinical features across obesity categories, a higher BMI remained associated with decreased 30-day and 1-year mortality (11% decrease at 30 days; 9% decrease at 1 year per 5 kg/m(2); p < 0.05), after adjustment for clinical risk. The BMI obtained at index admission provided effective 1-year risk reclassification beyond current markers of clinical risk (net reclassification index 0.119, p < 0.001). Notably, the "protective" association of BMI with mortality was confined to persons with older age (>75 years; hazard ratio [HR]: 0.82; p = 0.006), decreased cardiac function (ejection fraction <50%; HR: 0.85; p < 0.001), no diabetes (HR: 0.86; p < 0.001), and de novo HF (HR: 0.89; p = 0.004).CONCLUSIONS: A lower BMI is associated with age, disease severity, and a higher risk of death in acute decompensated HF. The "obesity paradox" is confined to older persons, with decreased cardiac function, less cardiometabolic illness, and recent-onset HF, suggesting that aging, HF severity/chronicity, and metabolism may explain the obesity paradox.
KW - Acute Disease
KW - Aged
KW - Aged, 80 and over
KW - Body Mass Index
KW - Cohort Studies
KW - Female
KW - Global Health
KW - Heart Failure
KW - Humans
KW - Internationality
KW - Male
KW - Middle Aged
KW - Obesity
KW - Prospective Studies
KW - Registries
U2 - 10.1016/j.jacc.2013.09.072
DO - 10.1016/j.jacc.2013.09.072
M3 - Article
C2 - 24315906
SN - 0735-1097
VL - 63
SP - 778
EP - 785
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -