Parissis John, Farmakis Dimitrios, Kadoglou Nikolaos, Ikonomidis Ignatios, Fountoulaki Ekaterini, Hatziagelaki Erifili, Deftereos Spyridon, Follath Ferenc, Mebazaa Alexandre, Lekakis John, Filippatos Gerasimos
Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
Eur J Heart Fail. 2016 Mar;18(3):298-305. doi: 10.1002/ejhf.489. Epub 2016 Jan 28.
Increased body mass index (BMI) is a risk factor for heart failure, but evidence regarding BMI in acute heart failure (AHF) remains inconclusive. We sought to compare the clinical profile, treatment and in-hospital outcome across BMI categories in a large international AHF cohort.
The Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF) is a retrospective survey on 4953 patients admitted for AHF from nine countries in Europe, Latin America, and Australia. Patients with unavailable BMI data or BMI <18.5 kg/m(2) were excluded. Clinical data and in-hospital mortality were compared among the following BMI categories: 18.5-24.9 kg/m(2) (normal weight), 25-29.9 kg/m(2) (overweight) and ≥30 kg/m(2) (obese).
Overweight/obese patients represented 75.7% of patients and had worse New York Heart Association class (P < 0.001) and higher admission systolic blood pressure (P < 0.001). The prevalence of comorbidities increased in parallel with BMI and included arterial hypertension, diabetes mellitus, dyslipidaemia (all P < 0.001), chronic obstructive pulmonary disease (P = 0.041) and chronic kidney disease (P = 0.056). Use of guideline-recommended medications also increased in parallel with BMI (angiotensin converting enzyme inhibitors/angiotensin II receptor blockers, P < 0.001; β-blockers P < 0.001; mineralocorticoid receptors antagonist, P = 0.002). In-hospital mortality had a U-shaped relationship with BMI, with overweight patients having significantly lower rate (log-rank P = 0.027); this relationship vanished after adjustment for confounders.
Overweight/obese patients represented the vast majority of AHF cases, had a higher prevalence of non-cardiovascular comorbidities and were more likely to receive guideline-recommended medications. The U-shaped relationship between in-hospital mortality and BMI may be explained by differences in clinical profile and treatment and not by an effect of body composition per se.
体重指数（BMI）升高是心力衰竭的一个危险因素，但关于急性心力衰竭（AHF）中BMI的证据仍不明确。我们试图在一个大型国际AHF队列中比较不同BMI类别患者的临床特征、治疗情况及住院结局。
急性心力衰竭标准治疗全球调查（ALARM-HF）是一项对来自欧洲、拉丁美洲和澳大利亚9个国家的4953例因AHF入院患者的回顾性调查。排除BMI数据不可用或BMI<18.5kg/m²的患者。比较以下BMI类别患者的临床数据和住院死亡率：18.5-24.9kg/m²（正常体重）、25-29.9kg/m²（超重）和≥30kg/m²（肥胖）。
超重/肥胖患者占患者总数的75.7%，纽约心脏协会心功能分级更差（P<0.001），入院收缩压更高（P<0.001）。合并症的患病率随BMI升高而增加，包括动脉高血压、糖尿病、血脂异常（均P<0.001）、慢性阻塞性肺疾病（P=0.041）和慢性肾脏病（P=0.056）。指南推荐药物的使用也随BMI升高而增加（血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂，P<0.001；β受体阻滞剂，P<0.001；盐皮质激素受体拮抗剂，P=0.002）。住院死亡率与BMI呈U型关系，超重患者死亡率显著较低（对数秩检验P=0.027）；调整混杂因素后这种关系消失。
超重/肥胖患者占AHF病例的绝大多数，非心血管合并症患病率更高，更有可能接受指南推荐的药物治疗。住院死亡率与BMI之间的U型关系可能是由临床特征和治疗差异而非身体组成本身的影响所致。
