Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.
Am J Cardiol. 2023 Nov 15;207:294-301. doi: 10.1016/j.amjcard.2023.09.024. Epub 2023 Sep 26.
The prognostic value of overweight/obesity in heart failure (HF) may vary according to HF etiologies. We aim to determine whether body mass index has differential impacts on survival among hospitalized HF patients with varying etiologies. Consecutive hospitalized HF patients between December 2006 and December 2017 were included. Multivariable analyses, including Cox proportional hazard models and restricted cubic splines, were used to investigate the impact of body mass index on mortality by HF etiology. Among the 3,836 patients included (mean age 57.1 years, 28.4% women), 1,475 (38.5%) were identified as having ischemic etiology. Of the remaining 2,361 patients with non-ischemic etiologies, dilated cardiomyopathy (DCM) accounted for 45.6% (n = 1,077). The rest of the patients were uniformly classified as having non-ischemic-non-DCM HF. The unadjusted data demonstrated an adiposity-related survival paradox in HF across all etiologies. However, the paradox holds only among non-ischemic-non-DCM HF patients after multivariate adjustment, wherein overweight patients exhibit the lowest mortality compared with their normal-weight counterparts (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.52 to 0.91), with a nadir in mortality risk at 28.18 kg/m. Similar survival benefits of overweight were not demonstrated in ischemic or DCM HF patients (ischemic etiology: aHR 1.07, 95% CI 0.84 to 1.36; DCM etiology: aHR 0.97, 95% CI 0.74 to 1.28). In conclusion, being overweight or obese does not confer better survival in HF patients of ischemic or DCM etiology, and the prognostic benefit of being overweight is maintained only in non-ischemic-non-DCM HF patients. Pathophysiologic interpretations are warranted, and whether patients of certain etiologies would benefit from weight reduction needs to be explored.
超重/肥胖对心力衰竭（HF）的预后价值可能因 HF 的病因而异。我们旨在确定体重指数（BMI）是否对不同病因的住院 HF 患者的生存有不同的影响。连续纳入 2006 年 12 月至 2017 年 12 月期间住院的 HF 患者。采用多变量分析，包括 Cox 比例风险模型和限制性立方样条，研究 BMI 对 HF 病因死亡率的影响。在纳入的 3836 例患者中（平均年龄 57.1 岁，28.4%为女性），1475 例（38.5%）被确定为缺血性病因。在其余 2361 例非缺血性病因的患者中，扩张型心肌病（DCM）占 45.6%（n=1077）。其余患者均归类为非缺血性非 DCMHF。未调整数据显示，所有病因的 HF 均存在肥胖相关的生存悖论。然而，在多变量调整后，这种悖论仅存在于非缺血性非 DCMHF 患者中，其中超重患者的死亡率最低，与正常体重患者相比（调整后的危险比[HR]0.69，95%置信区间[CI]0.52 至 0.91），死亡率风险的最低点为 28.18kg/m2。在缺血性或 DCMHF 患者中，超重并未显示出类似的生存获益（缺血性病因：HR1.07，95%CI0.84 至 1.36；DCM 病因：HR0.97，95%CI0.74 至 1.28）。总之，超重或肥胖并不能为缺血性或 DCM 病因的 HF 患者带来更好的生存，超重的预后获益仅在非缺血性非 DCMHF 患者中维持。需要进行病理生理学解释，并且需要探讨某些病因的患者是否会从体重减轻中获益。
