Department of Cardiology, Anzhen Hospital, Beijing, China.
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
ESC Heart Fail. 2024 Apr;11(2):709-718. doi: 10.1002/ehf2.14595. Epub 2023 Dec 22.
Relationship between body mass index (BMI), frailty, and clinical adverse events remains unclear in patients with heart failure (HF) with preserved ejection fraction (HFpEF) in different patient populations. We aimed to compare the association of BMI, frailty, and clinical adverse events between a US cohort from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study and a Chinese cohort from the Heart Failure Registry of Patient Outcomes (HERO) study.
We used data of 1715 participants enrolled from America in the TOPCAT study and 1487 patients with HFpEF in the Chinese registry study, the HERO. We evaluated the relationship between BMI and frailty using multivariate restricted cubic spline logistic regression. Association between frailty and BMI categories and primary outcomes including HF hospitalization, aborted sudden death, and cardiovascular death, all-cause mortality, and HF hospitalization were analysed by Cox proportional hazards models. The patients' mean age was 72 ± 11 years for both study populations, with 50% and 46% female for the TOPCAT study and the HERO study, respectively. Patients in the TOPCAT study had a higher mean BMI (33.9 vs. 24 kg/m), with 72.3% vs. 52.9% defined as moderately to severely frail (frailty index > 0.3). In the TOPCAT study, risk of frailty rose as BMI increased, but not in the HERO study. Patients with frailty were at significant higher risk for the primary composite outcomes [hazard ratio (HR) 1.84 (95% confidence interval: 1.46-2.32)], all-cause mortality [HR 1.73 (1.34-2.25)], and HF hospitalization [HR 1.83 (1.40-2.40)] in the TOPCAT study. The corresponding numbers in the HERO study were 1.26 (1.01-1.57), 2.21 (1.45-3.35), and 1.15 (0.81-1.37), respectively. The association of frailty with clinical outcomes did not vary with BMI categories in the two studies.
BMI distribution and association between BMI and frailty risk were different between the two study populations. Frailty was associated with clinical adverse events and this association was consistent across different BMI categories in both studies.
在不同患者人群的射血分数保留心衰（HFpEF）患者中，体重指数（BMI）、虚弱与临床不良事件之间的关系尚不清楚。我们旨在比较来自美国治疗保留心脏功能的心衰伴醛固酮拮抗剂（TOPCAT）研究的队列和来自中国心衰患者结局注册研究（HERO）的队列中 BMI、虚弱与临床不良事件的相关性。
我们使用来自美国 TOPCAT 研究的 1715 名参与者和中国 HERO 注册研究的 1487 名 HFpEF 患者的数据。我们使用多元受限立方样条逻辑回归评估 BMI 和虚弱之间的关系。通过 Cox 比例风险模型分析虚弱与 BMI 类别之间的关系以及主要结局（HF 住院、心源性猝死中止和心血管死亡、全因死亡率和 HF 住院）。两个研究人群的患者平均年龄为 72±11 岁，TOPCAT 研究和 HERO 研究的女性分别占 50%和 46%。TOPCAT 研究的患者平均 BMI 更高（33.9 比 24kg/m），72.3%比 52.9%被定义为中度至重度虚弱（虚弱指数>0.3）。在 TOPCAT 研究中，随着 BMI 的增加，虚弱的风险增加，但在 HERO 研究中并非如此。在 TOPCAT 研究中，虚弱患者发生主要复合结局的风险显著更高[风险比（HR）1.84（95%置信区间：1.46-2.32）]、全因死亡率[HR 1.73（1.34-2.25）]和 HF 住院[HR 1.83（1.40-2.40）]。HERO 研究中的相应数字分别为 1.26（1.01-1.57）、2.21（1.45-3.35）和 1.15（0.81-1.37）。在两项研究中，虚弱与临床结局的相关性不因 BMI 类别而变化。
两项研究人群的 BMI 分布和 BMI 与虚弱风险之间的关系不同。虚弱与临床不良事件相关，这种关联在两项研究的不同 BMI 类别中是一致的。
