The relationship between obesity and mortality in patients with heart failure

Horwich, Tamara B.; Fonarow, Gregg C.; Hamilton, Michèle A.; MacLellan, W. Robb; Woo, Mary A.; Tillisch, Jan H.

doi:10.1016/s0735-1097(01)01448-6

Cited by 750 publications

(535 citation statements)

References 24 publications

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“…Thus, the results of our study could not confirm the obesity paradox that has been reported in several other studies in those with CAD,28, 29, 30, 31, 32 heart failure,33, 34, 35, 36 and atrial fibrillation 37. The obesity paradox was addressed in a large meta‐analysis of patients with CAD, where it was observed that subjects with a low BMI had an increased relative risk for total mortality and cardiovascular mortality, whereas obese patients had no increased risk or even a lower risk for total mortality or cardiovascular mortality 3.…”

Section: Discussioncontrasting

confidence: 95%

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Medina‐Inojosa

Somers

Thomas

et al. 2018

JAHA

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BackgroundPrognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat‐free mass is associated with better prognosis.Methods and ResultsWe included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow‐up was performed using a record linkage system. Patients were classified in sex‐specific quartiles of BF% and fat‐free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow‐up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30–2.77; P=0.0008). In contrast, fat‐free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat‐free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35–0.82; P=0.004), when compared with those in the first quartile.ConclusionsIn patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat‐free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.

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Section: Discussioncontrasting

confidence: 95%

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Medina‐Inojosa

Somers

Thomas

et al. 2018

JAHA

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“…When estimated by BMI, obesity is associated with a favorable outcome in patients with HF, a phenomenon that is referred to as the obesity paradox 130, 131, 132, 133, 134, 135, 136. However, when obesity is assessed by indices of visceral obesity, such as waist circumference and waist‐hip ratio, the obesity paradox is no longer apparent 137.…”

Section: Obesity Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

109

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“…The counterintuitive relationship observed between higher BMI and improved survival after stroke has been described as an “obesity paradox” and is seen in other disease states such as heart failure and myocardial infarction 10, 11. Previous studies sampled only hospitalized patients without age‐matched control groups.…”

Section: Introductionmentioning

confidence: 99%

Overweight, Obesity, and Survival After Stroke in the Framingham Heart Study

Aparicio

Himali

Beiser

et al. 2017

JAHA

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BackgroundWe investigated how body weight affects survival after stroke, leveraging the availability of multiple prestroke body mass index (BMI) measurements and using a nested case‐control design in a community‐based sample.Methods and ResultsWe compared all‐cause mortality in participants stratified by prestroke weight. Separate analyses were performed for ischemic stroke and all stroke and for age‐, sex‐, and BMI category‐matched stroke‐free controls. Participants were grouped into BMI categories and followed for up to 10 years. Differences in survival were tested for interaction by case status. In sensitivity analysis, to exclude those with prestroke weight loss, we restricted the reference group to participants with 2 consistently normal BMI measurements within 10 years before stroke/matching. There were 782 stroke cases (age 71±9, 51% female participants, 87% ischemic stroke) and 2346 controls (age 72±9, 51% female participants). Overweight participants with ischemic stroke had a lower mortality compared with those with normal weight (hazard ratio [HR]=0.70, 95%CI 0.55‐0.90, P=0.005). The association of reduced mortality with BMI ≥25, compared with normal‐weight BMI 18.5 to <25, was pronounced among ischemic stroke cases but diminished with inclusion of hemorrhagic strokes (case‐control interaction P=0.051 and P=0.130, respectively). Compared with participants with stable normal weight, moderately increased weight was protective after ischemic stroke (overweight HR=0.72, 95%CI 0.53‐0.99, P=0.041).ConclusionsOverweight and mildly obese participants had better 10‐year survival after ischemic stroke compared with normal‐weight participants, even after excluding persons with recent prestroke weight loss. There may be unknown protective factors associated with a moderately increased body weight before stroke.

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The relationship between obesity and mortality in patients with heart failure

Cited by 750 publications

References 24 publications

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Overweight, Obesity, and Survival After Stroke in the Framingham Heart Study

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