Novel Adiposity Indices Are Associated With Poor Prognosis in Heart Failure With Preserved Ejection Fraction Without the Obesity Paradox.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
    • Publication Information:
      Original Publication: Oxford : Wiley-Blackwell
    • Subject Terms:
      Heart Failure*/physiopathology ; Heart Failure*/mortality ; Heart Failure*/diagnosis ; Stroke Volume*/physiology ; Obesity*/complications ; Obesity*/physiopathology ; Obesity*/epidemiology ; Body Mass Index* ; Adiposity*; Humans ; Male ; Female ; Aged ; Middle Aged ; Prognosis ; Risk Factors ; Hospitalization/statistics & numerical data ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Cause of Death/trends ; Risk Assessment ; Ventricular Function, Left/physiology ; Spironolactone/therapeutic use ; Obesity Paradox
    • Abstract:
      Background: There is limited study that illuminates the relationship between obesity indices and prognosis in patients with heart failure with preserved ejection fraction, nor has it been examined whether the obesity paradox persists when using these metrics.
      Methods and Results: This study is a post hoc analysis of data from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. A total of 3114 individuals were included in our final analysis, and a total of 481 (15.4%) all-cause deaths, and 389 (12.5%) heart failure hospitalizations were recorded. In a multivariable Cox regression model, compared with patients with a body mass index (BMI) <24.9 kg/m 2 , those with a BMI of 25.0-29.9, 30.0-34.9, and 35-39.9 kg/m 2 were associated with a decreased risk of all-cause death, with hazard ratio (95% CI) of 0.59 (0.45-0.78), 0.61 (0.46-0.82), and 0.66 (0.47-0.92), respectively. Conversely, patients with a BMI ≥40 kg/m 2 showed an increased risk of heart failure hospitalization, compared with BMI <24.9 kg/m 2 . Furthermore, patients in the highest quintile of obesity indices exhibited a significantly elevated hazard ratio for both all-cause death and heart failure hospitalization, compared with the lowest quintile.
      Conclusions: An elevated BMI over a certain range was associated with a reduced risk of all-cause death in heart failure with preserved ejection fraction, displaying a U-shaped relationship, with no mortality reduction observed in cases of extreme obesity. In contrast, higher values of novel obesity indices were positively correlated with all-cause death and heart failure hospitalization without the obesity paradox.
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    • Contributed Indexing:
      Keywords: adiposity indices; body mass index; heart failure with preserved ejection fraction; obesity paradox; prognosis; waist circumference
    • Accession Number:
      0 (Mineralocorticoid Receptor Antagonists)
      27O7W4T232 (Spironolactone)
    • Publication Date:
      Date Created: 20241104 Date Completed: 20241119 Latest Revision: 20250104
    • Publication Date:
      20250104
    • Accession Number:
      PMC11681387
    • Accession Number:
      10.1161/JAHA.124.035430
    • Accession Number:
      39494530