Update on Obesity and Obesity Paradox in Heart Failure (original) (raw)
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Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure
Obesity has reached epidemic proportions in the United States and worldwide. Considering the adverse effects of obesity on left ventricular (LV) structure, diastolic and systolic function, and other risk factors for heart failure (HF), including hypertension and coronary heart disease, HF incidence and prevalence, not surprisingly, is markedly increased in obese patients. Nevertheless, as with most other cardiovascular diseases, numerous studies have documented an obesity paradox, in which overweight and obese patients, defined by body mass index, percent body fat, or central obesity, demonstrate a better prognosis compared with lean or underweight HF patients. This review will describe the data on obesity in the context of cardiopulmonary exercise testing in HF. Additionally, the implications of obesity on LV assist devices and heart transplantation are reviewed. Finally, despite the obesity paradox, we address the current state of weight reduction in HF.
Anatomy of the obesity paradox in heart failure
Heart Failure Reviews, 2013
A counterintuitive phenomenon of survival advantage in obese patients with heart failure (HF) is called obesity paradox. In this review, we emphasize that in nearly all research papers on this subject, there were marked differences between the groups with different body mass index (BMI). Surprisingly, these differences are very consistent and mostly in favor of patients with higher BMI. Obese individuals in HF studies almost invariably were characterized by much younger age, better nutritional status, higher blood pressure, less arrhythmia, less anemia, less valvular regurgitation, better left ventricular systolic function, better lungs, and better renal function. There is no paradox in their better survival. None of the studies confirming the obesity paradox were designed as prospective studies with the purpose to find the effects of BMI on survival. All the studies represent post hoc analysis of clinical trials designed for different purposes, or retrospective studies, or analysis of registries. Multiple baseline differences of subgroups with different BMI likely contribute to the obesity paradox, because not all variables influencing the outcomes can be accounted for.
Obesity and Heart Failure: Understanding the Paradox
International Journal Of Scientific Advances
Obesity is a long established risk factor for cardiovascular diseases including heart failure. However, recent evidence suggests that obese patients with heart failure report more favorable outcomes than heart failure patients with normal weights. This paper presents, reviews, and discusses some of the currently available evidence describing the association between obesity and heart failure, especially obesity as a risk factor for heart failure and the obesity-heart failure paradox. Pathophysiological evidence and data from longitudinal studies are considered.
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.
Annals of medicine, 2016
Heart failure (HF) and obesity are major public health problems. Studies have shown that obesity may increase the risk of developing new HF but after patients have developed HF, obesity may be associated with improved outcomes. This paradoxical association of obesity with HF remains poorly understood. It is believed that the obesity paradox may in part be due to the inherent limitations of body mass index (BMI) as a measure of obesity. BMI may not appropriately measure important components of body mass like body fat, fat distribution, lean body mass, and body fluid content and may not be ideal for examining the relationship of body composition with health outcomes. Differentiating between body fat and lean body mass may explain some of the paradoxical association between higher BMI and better prognosis in patients with HF. Paradoxical outcomes in HF may also be due to phenotypes of obesity. Future studies need to develop and test metrics that may better measure body composition and ...
The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence
Journal of Obesity, 2016
There is scientific consensus that obesity increases the risk of cardiovascular diseases, including heart failure. However, among persons who already have heart failure, outcomes seem to be better in obese persons as compared with lean persons: this has been termed theobesity paradox, the mechanisms of which remain unclear. This study systematically reviewed the evidence of the relationship between heart failure mortality (and survival) and weight status. Search of the PubMed/MEDLINE and EMBASE databases was done according to the PRISMA protocol. The initial search identified 9879 potentially relevant papers, out of which ten studies met the inclusion criteria. One study was a randomized clinical trial and 9 were observational cohort studies: 6 prospective and 3 retrospective studies. All studies used the BMI, WC, or TSF as measure of body fatness and NYHA Classification of Heart Failure and had single outcomes, death, as study endpoint. All studies included in review were longitudi...
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.