Effect of obesity and being overweight on long-term mortality in congestive heart failure: influence of left ventricular systolic function (original) (raw)
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Lack of Association between Obesity and Left Ventricular Systolic Dysfunction
Echocardiography, 2009
Background: Previous studies have demonstrated that obesity is one of the risk factors for congestive heart failure (CHF). By analyzing a large database, we investigated any association between body mass index (BMI) and left ventricular (LV) systolic dysfunction. Methods: We retrospectively analyzed 24,265 echocardiograms performed between 1984 and 1998. Fractional shortening (FS) and BMI were available for 13,382 subjects in this cohort which were used for data analysis. FS was stratified into four groups: (1) FS > 25%, (2) FS 17.5-25%, (3) FS 10-17.5%, and (4) FS < 10%. Furthermore, we also used final diagnosis that was coded by the reading cardiologist as mild, moderate, and severe LV dysfunction separately for data analysis. BMI was divided into four groups: BMI < 18.5 kg/m 2 (underweight), 18.5-24.9 kg/m 2 (normal), 25-30 kg/m 2 (overweight), and >30 kg/m 2 (obese). Results: There was no association between different BMI categories and LV systolic function. The prevalence of mild, moderate, or severely decreased LV function (based on FS or subjective interpretation of reading cardiologists) was equally distributed between the groups. Obese patients (BMI > 30%) had normal FS of >25 in 16.9%, mildly decreased FS in 18%, moderately decreased FS in 18.4%, and severely decreased FS in 20.1% P = ns. Conclusion: Our study is consistent with previous trials suggesting that obesity is not related to systolic LV dysfunction. The underlying mechanism for the occurrence of congestive heart failure in obese patients needs further investigation.
Does Body Mass Index Influence Mortality in Patients With Heart Failure?
Revista Española de Cardiología (English Edition), 2007
Obesity is an independent risk factor for congestive heart failure. Paradoxically, improved survival has been observed in obese heart failure patients. The objective of this study was to analyze the relationship between body mass index (BMI) and the 2-year mortality rate in outpatients with heart failure of different etiologies who were attending a heart failure unit.
Journal of the American Academy of Nurse Practitioners, 2008
Purpose: The purpose of this review was to summarize the literature on the relationship between obesity and survival in persons with heart failure (HF). In particular, the article examines the ways in which studies define body size/ composition (body mass index [BMI], body composition, weight, cachexia, fluid retention, or albumin) and the relationship of BMI and survival after controlling for factors such as HF severity, etiology of the HF, gender, race, age, and/or time since HF diagnosis.
Body mass index and mortality in heart failure: a meta-analysis
American heart …, 2008
Background In patients with chronic heart failure (CHF), previous studies have reported reduced mortality rates in patients with increased body mass index (BMI). The potentially protective effect of increased BMI in CHF has been termed the obesity paradox or reverse epidemiology. This meta-analysis was conducted to examine the relationship between increased BMI and mortality in patients with CHF.
The Paradox of Obesity in Patients with Heart Failure
Journal of The American Academy of Nurse Practitioners, 2005
PurposeHeart failure (HF) patients often have comorbid conditions that confound management and adversely affect prognosis. The purpose of this study was to determine whether the obesity paradox is also present in hospitalized HF patients in an integrated healthcare system.Heart failure (HF) patients often have comorbid conditions that confound management and adversely affect prognosis. The purpose of this study was to determine whether the obesity paradox is also present in hospitalized HF patients in an integrated healthcare system.Data sourcesA cohort of 2707 patients with a primary diagnosis of HF was identified within an integrated, 20-hospital healthcare system. Patients were identified by ICD-9 codes or a left ventricular ejection fraction ≤40% dating back to 1995. Body mass index (BMI) was calculated using the first measured height and weight when hospitalized with HF. Survival rates were calculated using Kaplan Meier estimation. Hazard ratios for 3-year mortality with 95% confidence intervals were assessed using Cox regression, controlling for age, gender, and severity of illness at time of diagnosis.A cohort of 2707 patients with a primary diagnosis of HF was identified within an integrated, 20-hospital healthcare system. Patients were identified by ICD-9 codes or a left ventricular ejection fraction ≤40% dating back to 1995. Body mass index (BMI) was calculated using the first measured height and weight when hospitalized with HF. Survival rates were calculated using Kaplan Meier estimation. Hazard ratios for 3-year mortality with 95% confidence intervals were assessed using Cox regression, controlling for age, gender, and severity of illness at time of diagnosis.ConclusionsThree-year survival rates paradoxically improved for patients with increasing BMI. Survival rates for the larger three BMI quartiles were significantly better than for the lowest quartile after adjusting for severity of illness, age, and gender.Three-year survival rates paradoxically improved for patients with increasing BMI. Survival rates for the larger three BMI quartiles were significantly better than for the lowest quartile after adjusting for severity of illness, age, and gender.Implications for practiceWhile obesity increases the risk of developing HF approximately twofold, reports involving stable outpatients suggest that obesity is associated with improved survival after the development of HF. This finding is paradoxical because obesity increases the risk and worsens the prognosis of other cardiovascular diseases.While obesity increases the risk of developing HF approximately twofold, reports involving stable outpatients suggest that obesity is associated with improved survival after the development of HF. This finding is paradoxical because obesity increases the risk and worsens the prognosis of other cardiovascular diseases.
Impact of Body Mass Index on Clinical Outcome in Patients Hospitalized With Congestive Heart Failure
Circulation Journal, 2012
or.jp besity has been considered to be associated with cardiovascular diseases: as body mass index (BMI) increases, the risk of congestive heart failure (CHF) increases. 1 In the Guidelines for Treatment of Chronic Heart Failure (JCS 2010) in Japan, physicians are recommended to ask obese patients with CHF to reduce their caloric intake in order to lose weight. Recent reports, however, have shown that obese patients with CHF have more favorable clinical outcomes. 2 These favorable effects of obesity, termed the "obesity paradox", are also seen in patients with other cardiovascular diseases, such as hypertension and coronary heart disease. 3 This phenomenon might be partly due to selection bias. In a large meta-analysis (total n=28,209), however, obesity was still related to better outcomes after adjusting for known risk factors. 4 Although Japanese patients tend to be less obese than Euro-pean/US patients, and the average BMI is much lower in Japan, only a few studies are available on Japanese populations. 5,6 The purpose of the present study was therefore to investigate the impact of BMI on prognosis after the development of CHF.
Influence of Etiology of Heart Failure on the Obesity Paradox
The American Journal of Cardiology, 2009
Several investigations have demonstrated that higher body weight, as assessed by body mass index (BMI), is associated with improved prognosis in patients with heart failure (HF). The purpose of the present investigation was to assess the influence of HF etiology on the prognostic ability of BMI in a cohort undergoing cardiopulmonary exercise testing (CPX). One thousand one hundred and sixty subjects were included in the analysis. All subjects underwent CPX where the minute ventilation/ carbon dioxide production (VE/VCO 2 ) slope and peak oxygen consumption (VO 2 ) were determined. There were 193 cardiac deaths in the overall group during a mean follow-up of 30.7 ±25.6 months (annual event rate: 6.0%). Subjects classified as obese consistently had improved survival compared to normal weight subjects (overall survival 88.0% vs. ≤81.1%, p<0.001). Differences in survival according to HF etiology were observed for subjects classified as overweight. In the ischemic subgroup, survival characteristics for overweight subjects (75.5%) were similar to individuals classified as normal weight (81.1%). The converse was true for the non-ischemic subgroup where survival trends for obese (86.4%) and overweight subjects (88.4%) were similar. The VE/VCO 2 slope was the strongest prognostic marker (Chi-square: ≥43.4, p<0.001) for both etiologies while BMI added prognostic value (Residual Chi-square: ≥4.7, p<0.05). In conclusion, these results further support the notion that obesity confers improved prognosis in patients with HF, irrespective of HF etiology. Moreover, BMI appears to add predictive value during CPX assessment. However, survival appears to differ according to HF etiology in subjects classified as overweight.