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The obesity paradox...
The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data
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Padwal, R. (författare)
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McAlister, F. A. (författare)
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McMurray, J. J. (författare)
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visa fler...
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Cowie, M. R. (författare)
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Rich, M. (författare)
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Pocock, S. (författare)
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- Swedberg, Karl, 1944 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Maggioni, A. (författare)
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Gamble, G. (författare)
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Ariti, C. (författare)
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Earle, N. (författare)
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Whalley, G. (författare)
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Poppe, K. K. (författare)
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Doughty, R. N. (författare)
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Bayes-Genis, A. (författare)
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(creator_code:org_t)
- 2013-10-31
- 2014
- Engelska.
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 38:8, s. 1110-1114
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- Background:In heart failure (HF), obesity, defined as body mass index (BMI) >/=30 kg m-2, is paradoxically associated with higher survival rates compared with normal-weight patients (the 'obesity paradox'). We sought to determine if the obesity paradox differed by HF subtype (reduced ejection fraction (HF-REF) versus preserved ejection fraction (HF-PEF)).Patients and Methods:A sub-analysis of the MAGGIC meta-analysis of patient-level data from 14 HF studies was performed. Subjects were divided into five BMI groups: <22.5, 22.5-24.9 (referent), 25-29.9, 30-34.9 and >/=35 kg m-2. Cox proportional hazards models adjusted for age, sex, aetiology (ischaemic or non-ischaemic), hypertension, diabetes and baseline blood pressure, stratified by study, were used to examine the independent association between BMI and 3-year total mortality. Analyses were conducted for the overall group and within HF-REF and HF-PEF groups.Results:BMI data were available for 23 967 subjects (mean age, 66.8 years; 32% women; 46% NYHA Class II; 50% Class III) and 5609 (23%) died by 3 years. Obese patients were younger, more likely to receive cardiovascular (CV) drug treatment, and had higher comorbidity burdens. Compared with BMI levels between 22.5 and 24.9 kg m-2, the adjusted relative hazards for 3-year mortality in subjects with HF-REF were: hazard ratios (HR)=1.31 (95% confidence interval=1.15-1.50) for BMI <22.5, 0.85 (0.76-0.96) for BMI 25.0-29.9, 0.64 (0.55-0.74) for BMI 30.0-34.9 and 0.95 (0.78-1.15) for BMI >/=35. Corresponding adjusted HRs for those with HF-PEF were: 1.12 (95% confidence interval=0.80-1.57) for BMI <22.5, 0.74 (0.56-0.97) for BMI 25.0-29.9, 0.64 (0.46-0.88) for BMI 30.0-34.9 and 0.71 (0.49-1.05) for BMI >/=35.Conclusions:In patients with chronic HF, the obesity paradox was present in both those with reduced and preserved ventricular systolic function. Mortality in both HF subtypes was U-shaped, with a nadir at 30.0-34.9 kg m-2.International Journal of Obesity advance online publication, 26 November 2013; doi:10.1038/ijo.2013.203.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
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Padwal, R.
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McAlister, F. A.
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McMurray, J. J.
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Cowie, M. R.
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Rich, M.
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Pocock, S.
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visa fler...
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Swedberg, Karl, ...
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Maggioni, A.
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Gamble, G.
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Ariti, C.
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Earle, N.
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Whalley, G.
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Poppe, K. K.
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Doughty, R. N.
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Bayes-Genis, A.
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visa färre...
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