Division of Cardiology, Osaka Rosai Hospital.
Division of Cardiology, Osaka General Medical Center.
Int Heart J. 2021 Sep 30;62(5):1042-1051. doi: 10.1536/ihj.21-195. Epub 2021 Sep 17.
The obesity paradox states higher body mass index (BMI) is associated with better outcomes than normal weight in patients with heart failure with preserved ejection fraction (HFpEF). However, underweight was defined by BMI < 18.5 kg/m, and results have been inconclusive, in part due to small number of participants. The number of underweight patients with HFpEF is higher in Asian than in Western countries. In this study, we aim to determine the prognostic impact of underweight in patients with HFpEF in Asian population.We enrolled 846 consecutive patients from the PURSUIT-HFpEF registry. We then divided them into three groups by BMI, namely, underweight (BMI < 18.5 kg/m), normal weight (18.5 ≤ BMI < 23), and overweight (23 ≤ BMI). The underweight group consisted of 187 patients (22%). Over a mean follow-up of 407 days, 105 deaths were reported as all-cause mortality. On multivariable Cox analysis, the underweight group was determined to be significantly associated with higher risk of all-cause mortality than the normal and overweight groups (Hazard ratios [HR]: 2.33; 95% confidence intervals [CI]: 1.45-3.75, P < 0.001; HR: 3.54; 95% CI: 1.99-6.29, P < 0.001, respectively), after adjustment for age, sex, vital signs, and comorbidities.Underweight is a useful predictor of poor prognosis in patients with HFpEF in Asian population.
肥胖悖论表明，与心力衰竭射血分数保留（HFpEF）患者的正常体重相比，较高的体重指数（BMI）与更好的结局相关。然而，体重过轻是通过 BMI<18.5kg/m 来定义的，并且结果尚无定论，部分原因是参与者人数较少。与西方国家相比，亚洲国家 HFpEF 患者中体重过轻的人数更多。在这项研究中，我们旨在确定亚洲人群中 HFpEF 患者体重过轻对预后的影响。我们从 PURSUIT-HFpEF 登记处招募了 846 例连续患者。然后，我们根据 BMI 将他们分为三组，即体重过轻（BMI<18.5kg/m）、正常体重（18.5≤BMI<23）和超重（23≤BMI）。体重过轻组包括 187 名患者（22%）。在平均 407 天的随访中，报告了 105 例全因死亡。多变量 Cox 分析表明，与正常体重和超重组相比，体重过轻组全因死亡率的风险显著更高（危险比[HR]：2.33；95%置信区间[CI]：1.45-3.75，P<0.001；HR：3.54；95%CI：1.99-6.29，P<0.001），校正年龄、性别、生命体征和合并症后。在亚洲人群中，体重过轻是 HFpEF 患者预后不良的有用预测指标。
