Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria.
IT Systems and Communications, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria.
Eur J Prev Cardiol. 2023 Sep 6;30(12):1247-1254. doi: 10.1093/eurjpc/zwad140.
Heart failure with preserved ejection fraction (HFpEF) is a condition that commonly coexists with type 2 diabetes mellitus (T2DM) and obesity. Whether the obesity-related survival benefit generally observed in HFpEF extends to individuals with concomitant T2DM is unclear. This study sought to examine the prognostic role of overweight and obesity in a large cohort of HFpEF with and without T2DM.
This large-scale cohort study included patients with HFpEF enrolled between 2010 and 2020. The relationship between body mass index (BMI), T2DM, and survival was assessed. A total of 6744 individuals with HFpEF were included, of which 1702 (25%) had T2DM. Patients with T2DM had higher BMI values (29.4 kg/m2 vs. 27.1 kg/m2, P < 0.001), higher N-terminal pro-brain natriuretic peptide values (864 mg/dL vs. 724 mg/dL, P < 0.001), and a higher prevalence of numerous risk factors/comorbidities than those without T2DM. During a median follow-up time of 47 months (Q1-Q3: 20-80), 2014 (30%) patients died. Patients with T2DM had a higher incidence of fatal events compared with those without T2DM, with a mortality rate of 39.2% and 26.7%, respectively (P < 0.001). In the overall cohort, using the BMI category 22.5-24.9 kg/m2 as the reference group, the unadjusted hazard ratio (HR) for all-cause death was increased in patients with BMI <22.5 kg/m2 [HR: 1.27 (confidence interval 1.09-1.48), P = 0.003] and decreased in BMI categories ≥25 kg/m2. After multivariate adjustment, BMI remained significantly inversely associated with survival in non-T2DM, whereas survival was unaltered at a wide range of BMI in patients with T2DM.
Among the various phenotypes of HFpEF, the T2DM phenotype is specifically associated with a greater disease burden. Higher BMI is linked to improved survival in HFpEF overall, while this effect neutralises in patients with concomitant T2DM. Advising BMI-based weight targets and weight loss may be pursued with different intensity in the management of HFpEF, particularly in the presence of T2DM.
射血分数保留的心力衰竭（HFpEF）是一种常与 2 型糖尿病（T2DM）和肥胖并存的疾病。肥胖相关的生存获益是否扩展到同时患有 T2DM 的个体尚不清楚。本研究旨在探讨超重和肥胖在伴有和不伴有 T2DM 的大量 HFpEF 患者中的预后作用。
本大规模队列研究纳入了 2010 年至 2020 年间纳入的 HFpEF 患者。评估了体重指数（BMI）、T2DM 与生存之间的关系。共纳入 6744 例 HFpEF 患者，其中 1702 例（25%）患有 T2DM。患有 T2DM 的患者 BMI 值更高（29.4kg/m2 比 27.1kg/m2，P<0.001），N 端脑利钠肽前体值更高（864mg/dL 比 724mg/dL，P<0.001），且存在更多危险因素/合并症的比例高于无 T2DM 患者。在中位随访时间 47 个月（Q1-Q3：20-80）期间，2014 例（30%）患者死亡。与无 T2DM 患者相比，患有 T2DM 的患者发生致命事件的发生率更高，死亡率分别为 39.2%和 26.7%（P<0.001）。在整个队列中，以 BMI 类别 22.5-24.9kg/m2 作为参考组，BMI<22.5kg/m2 的患者全因死亡的未调整危险比（HR）增加（HR：1.27（95%置信区间 1.09-1.48），P=0.003），而 BMI≥25kg/m2 的患者死亡风险降低。在多变量调整后，BMI 与非 T2DM 患者的生存呈显著负相关，而 T2DM 患者的 BMI 范围广泛，对生存无影响。
在 HFpEF 的各种表型中，T2DM 表型与更大的疾病负担相关。在 HFpEF 患者中，较高的 BMI 与生存改善相关，而在同时患有 T2DM 的患者中，这种影响则消失。在 HFpEF 的管理中，根据 BMI 指导体重目标和减轻体重可能需要不同的强度，特别是在存在 T2DM 的情况下。
