Revisiting the obesity paradox in heart failure: Per cent body fat as predictor of biomarkers and outcome

Alberto Aimo, James L. Januzzi, Giuseppe Vergaro, Aldo Clerico, Roberto Latini, Jennifer Meessen, Inder S. Anand, Jay N. Cohn, Jorgen Gravning, Thor Ueland, Stale H. Nymo, Hans-Peter Brunner-La Rocca, Antoni Bayes-Genis, Josep Lupon, Rudolf A. de Boer, Akiomi Yoshihisa, Yasuchika Takeishi, Michael Egstrup, Ida Gustafsson, Hanna K. GaggingKai M. Eggers, Kurt Huber, Ioannis Tentzeris, Andrea Ripoli, Claudio Passino, Michele Emdin*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

19 Citations (Web of Science)

Abstract

Aims Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)). Methods In an individual patient dataset, BMI was calculated as weight (kg)/height (m) (2) , and PBF through the Jackson-Pollock and Gallagher equations. Results Out of 6468 patients (median 68 years, 78% men, 76% ischaemic heart failure, 90% reduced ejection fraction), 24% died over 2.2 years (1.5-2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4-33.0%) with the Jackson-Pollock equation, and 28.0% (23.8-33.5%) with the Gallagher equation, with an extremely strong correlation (r = 0.996, p <0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI >= 30 kg/m(2), third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome. Conclusion In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.

Original languageEnglish
Article number2047487319852809
Pages (from-to)1751-1759
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Volume26
Issue number16
DOIs
Publication statusPublished - Nov 2019

Keywords

  • AGE
  • ARTERIAL STIFFNESS
  • CIRCUMFERENCE
  • DISEASE
  • MASS INDEX
  • MORTALITY
  • Obesity
  • SEX
  • TROPONIN-T
  • heart failure
  • natriuretic peptides
  • prognosis
  • sST2
  • troponin
  • TO-HIP RATIO
  • PROBNP

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