David Geffen School of Medicine, University of California, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA.
J Card Fail. 2011 May;17(5):374-80. doi: 10.1016/j.cardfail.2011.01.009. Epub 2011 Mar 25.
Higher body mass index (BMI) is associated with improved heart failure (HF) survival, but the role of waist circumference (WC) in HF outcomes has not been studied.
A total of 344 patients with advanced systolic HF had WC and BMI measured at presentation. High WC was defined as ≥88 cm in women and ≥102 cm in men, and high BMI as ≥25 kg/m(2). Two-year urgent heart transplant (UT)-free survival in high vs normal WC groups was 77.9% vs 64.3% (P = .025) and in high vs normal BMI was 89.8% vs 58.2% (P < .001). After multivariable adjustment, normal WC compared with high WC was associated with higher all-cause mortality (risk ratio [RR] 2.76, 95% confidence interval [CI] 1.34-5.71) and higher risk of death/UT (RR 2.14, 95% CI 1.25-3.68). The best outcomes were seen in those with both high WC and high BMI.
High WC, an alternative anthropometric index of obesity more specific to abdominal adiposity, high BMI, and the combination of high WC/high BMI were each associated with improved outcomes in this advanced HF cohort, lending further support for an obesity paradox in HF. The role of body composition in HF survival should be a focus of future investigation.
较高的体重指数（BMI）与改善心力衰竭（HF）的生存有关，但腰围（WC）在 HF 结局中的作用尚未得到研究。
共有 344 名患有晚期收缩性 HF 的患者在就诊时测量了 WC 和 BMI。WC 高定义为女性≥88cm，男性≥102cm，BMI 高定义为≥25kg/m²。WC 高组与正常 WC 组相比，2 年无紧急心脏移植（UT）生存率为 77.9%与 64.3%（P=0.025），BMI 高组与正常 BMI 组相比为 89.8%与 58.2%（P＜0.001）。多变量调整后，与 WC 正常组相比，WC 高组全因死亡率更高（风险比[RR]2.76，95%置信区间[CI]1.34-5.71）和死亡/UT 风险更高（RR 2.14，95% CI 1.25-3.68）。WC 高和 BMI 高的患者预后最佳。
WC 高，一种更特定于腹部肥胖的肥胖替代人体测量指标，高 BMI 以及 WC 高/高 BMI 的组合，在这一晚期 HF 患者队列中均与改善结局相关，进一步支持 HF 中的肥胖悖论。身体成分在 HF 生存中的作用应成为未来研究的重点。
