Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Division of Cardiovascular Medicine, University of Texas Health Sciences Center, Houston, TX, USA.
Int J Obes (Lond). 2020 Jul;44(7):1561-1567. doi: 10.1038/s41366-020-0563-1. Epub 2020 Jun 1.
Limited data exist on the association of obesity with both hospitalization and mortality in patients with heart failure with preserved ejection fraction (HFpEF), especially in the real-world ambulatory setting. We hypothesized that increasing body-mass index (BMI) in ambulatory heart failure with preserved ejection fraction would have a protective effect on these patients leading to decreased mortality and hospitalizations.
We studied the relationship between BMI and the time to all-cause mortality, time to heart failure (HF) hospitalization, and time to all-cause hospitalization over a 2-year follow-up in a national cohort of 2501 ambulatory HFpEF patients at 153 Veterans Affairs medical centers.
Compared with normal BMI, overweight (HR 0.72; 95% CI 0.57-0.91), obesity class I (HR 0.59; 95% CI 0.45-0.77), obesity class II (HR 0.56; 95% CI 0.40-0.77), and obesity class III (HR 0.53; 95% CI 0.36-0.77) were associated with improved survival after adjustment for demographics and comorbidities. In contrast, the time to HF hospitalization showed an inverse relationship, with shorter time to HF hospitalization with increasing BMI compared with normal BMI; overweight (adjusted HR 1.30; 95% CI 0.88-1.90), obesity class I (HR 1.57; 95% CI 1.05-2.34), obesity class II (HR 1.79; 95% CI 1.15-2.78), and obesity class III (HR 1.96; 95% CI 1.23-3.12). However, time to first all-cause hospitalization was not significantly different by BMI groups.
In a large, national ambulatory HFpEF cohort, despite the presence of the obesity paradox with respect to survival, increasing BMI was independently associated with an increased risk of HF hospitalization and similar risk of all-cause hospitalization. Future longer-term prospective trials evaluating the safety and efficacy of weight loss on morbidity and mortality, in patients with severe obesity and HFpEF are needed.
在射血分数保留的心力衰竭（HFpEF）患者中，肥胖与住院和死亡的相关性数据有限，尤其是在真实世界的门诊环境中。我们假设，在门诊 HFpEF 患者中，体重指数（BMI）的增加将对这些患者产生保护作用，从而降低死亡率和住院率。
我们在 153 家退伍军人事务医疗中心的 2501 名门诊 HFpEF 患者的全国队列中，研究了 BMI 与全因死亡率、心力衰竭（HF）住院时间和全因住院时间之间的关系，随访时间为 2 年。
与正常 BMI 相比，超重（HR 0.72；95%CI 0.57-0.91）、肥胖 I 级（HR 0.59；95%CI 0.45-0.77）、肥胖 II 级（HR 0.56；95%CI 0.40-0.77）和肥胖 III 级（HR 0.53；95%CI 0.36-0.77）与调整人口统计学和合并症后的生存改善相关。相比之下，HF 住院时间呈反比关系，与正常 BMI 相比，BMI 增加与 HF 住院时间缩短相关；超重（调整 HR 1.30；95%CI 0.88-1.90）、肥胖 I 级（HR 1.57；95%CI 1.05-2.34）、肥胖 II 级（HR 1.79；95%CI 1.15-2.78）和肥胖 III 级（HR 1.96；95%CI 1.23-3.12）。然而，BMI 组之间首次全因住院时间无显著差异。
在一个大型的全国性门诊 HFpEF 队列中，尽管存在与生存相关的肥胖悖论，但 BMI 的增加与 HF 住院风险的增加独立相关，与全因住院风险相似。需要进行更长时间的前瞻性试验，评估严重肥胖和 HFpEF 患者体重减轻对发病率和死亡率的安全性和有效性。
