The Relation of Body Mass Index to Biochemical Parameters and Profile of Heart Failure (original) (raw)
Related papers
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 ...
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.
Does Body Mass Index Really Matter in the Management of Heart Failure?: A Review of the Literature
Cardiology in Review, 2008
Excess body weight increases the risk for many disorders including cardiovascular disease and such patients have a greater risk for developing heart failure (HF). Despite evidence demonstrating the adverse effects of excess weight, the relationship between body mass index (BMI) and mortality in HF patients remains controversial. Paradoxically, several large cohort studies have shown that overweight and obese HF patients seem to have better survival than their healthy weight counterparts. The exact mechanism for this "obesity paradox" is not fully understood. Proposed mechanisms include a greater tolerance to angiotensin-converting enzyme inhibition, higher serum lipid levels, and the alteration of inflammatory cytokine metabolism in obese patients. Although the relationship between elevated BMI and improved survival has been well documented, recent clinical trials have not addressed this association. In 65 of 75 clinical HF trials reviewed, BMI as a potential independent predictor of outcomes was not addressed. Furthermore, the variation of pharmacokinetics in the obese population has been dealt with to a limited degree. If data concerning BMI and weight loss is to directly impact treatment recommendations for HF patients, well-designed clinical trials are needed.
Update on Obesity and Obesity Paradox in Heart Failure
Progress in Cardiovascular Diseases, 2015
Obesity has reached epidemic proportions in most of the Westernized world. Overweightness and obesity adversely impact cardiac structure and function, including on both the right and , especially, left sides of the heart, with adverse affects on systolic and, especially, diastolic ventricular function. Therefore, it is not surprising that obesity makedly increases the prevalence of heart failure (HF). Nevertheless, many studies have documented an obesity paradox in large cohorts with HF, where overweight and obese have a better prognosis, at least in the short-term, compared with lean HF patients. Although weight loss clearly improves cardiac structure and function and reduces symptoms in HF, there are no large studies on the impact of weight loss on clinical events in HF, preventing definitive guidelines on optimal body composition in patients with HF.
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.
BMC Geriatrics, 2021
Background Although high body mass index (BMI) is a risk factor of heart failure (HF), HF patients with a higher BMI had a lower mortality rate than that in HF patients with normal or lower BMI, a phenomenon that has been termed the “obesity paradox”. However, the relationship between body composition, i.e., fat or muscle mass, and clinical outcome in HF remains unclear. Methods We retrospectively analyzed data for 198 consecutive HF patients (76 years of age; males, 49%). Patients who were admitted to our institute for diagnosis and management of HF and received a dual-energy X-ray absorptiometry scan were included regardless of left ventricular ejection fraction (LVEF) categories. Muscle wasting was defined as appendicular skeletal muscle mass index < 7.0 kg/m2 in males and < 5.4 kg/m2 in females. Increased percent body fat mass (increased FM) was defined as percent body fat > 25% in males and > 30% in females. Results The median age of the patients was 76 years (inter...
Obesity Paradox: Comparison of Heart Failure Patients With and Without Comorbid Diabetes
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2017
Diabetes is a common comorbid condition in patients with heart failure and is strongly associated with poor outcomes. Patients with heart failure who have diabetes are more likely to be obese than are those without diabetes. Obesity is positively associated with survival in patients with heart failure, but how comorbid diabetes influences the relationship between obesity and favorable prognosis is unclear. To explore whether the relationship between body mass index and survival differs between patients with heart failure who do or do not have diabetes. The sample consisted of 560 ambulatory patients with heart failure (mean age, 66 years; mean body mass index, 32; diabetes, 41%). The association between body mass index and all-cause mortality was examined by using multivariate Cox proportional hazards regression after adjustments for covariates. In patients without diabetes, higher body mass index was associated with a lower risk for all-cause mortality after adjustments for covaria...
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.
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.