Butt Jawad H, Thune Jens Jakob, Nielsen Jens C, Haarbo Jens, Videbæk Lars, Gustafsson Finn, Kristensen Søren L, Bruun Niels E, Eiskjær Hans, Brandes Axel, Hassager Christian, Svendsen Jesper H, Høfsten Dan E, Torp-Pedersen Christian, Schou Morten, Pehrson Steen, Packer Milton, McMurray John J V, Køber Lars
Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Eur J Heart Fail. 2025 Mar;27(3):527-536. doi: 10.1002/ejhf.3424. Epub 2024 Aug 18.
Although body mass index (BMI) is the most commonly used anthropometric measure to assess adiposity, alternative indices such as the waist-to-height ratio may better reflect the location and amount of ectopic fat as well as the weight of the skeleton.
The prognostic value of several alternative anthropometric measures was compared with that of BMI in 1116 patients with non-ischaemic heart failure with reduced ejection fraction (HFrEF) enrolled in DANISH. The association between anthropometric measures and all-cause death was adjusted for prognostic variables, including natriuretic peptides. Median follow-up was 9.5 years (25th-75th percentile, 7.9-10.9). Compared to patients with a BMI 18.5-24.9 kg/m (n = 363), those with a BMI ≥25 kg/m had a higher risk of all-cause and cardiovascular death, although this association was only statistically significant for a BMI ≥35 kg/m (n = 91) (all-cause death: hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.28-2.48; cardiovascular death: HR 2.46, 95% CI 1.69-3.58). Compared to a BMI 18.5-24.9 kg/m, a BMI <18.5 kg/m (n = 24) was associated with a numerically, but not a significantly, higher risk of all-cause and cardiovascular death. Greater waist-to-height ratio (as an exemplar of indices not incorporating weight) was also associated with a higher risk of all-cause and cardiovascular death (HR for the highest vs. the lowest quintile: all-cause death: HR 2.11, 95% CI 1.53-2.92; cardiovascular death: HR 2.17, 95% CI 1.49-3.15).
In patients with non-ischaemic HFrEF, there was a clear association between greater adiposity and higher long-term mortality.
ClinicalTrials.gov NCT00542945.
尽管体重指数（BMI）是评估肥胖最常用的人体测量指标，但诸如腰高比等替代指标可能能更好地反映异位脂肪的位置和数量以及骨骼重量。
在丹麦进行的一项研究中，对1116例射血分数降低的非缺血性心力衰竭（HFrEF）患者，比较了几种替代人体测量指标与BMI的预后价值。人体测量指标与全因死亡之间的关联针对包括利钠肽在内的预后变量进行了校正。中位随访时间为9.5年（第25-75百分位数，7.9-10.9）。与BMI为18.5-24.9kg/m²的患者（n = 363）相比，BMI≥25kg/m²的患者全因死亡和心血管死亡风险更高，不过这种关联仅在BMI≥35kg/m²的患者（n = 91）中具有统计学意义（全因死亡：风险比[HR] 1.78，95%置信区间[CI] 1.28-2.48；心血管死亡：HR 2.46，95%CI 1.69-3.58）。与BMI为18.5-24.9kg/m²相比，BMI<18.5kg/m²的患者（n = 24）全因死亡和心血管死亡风险在数值上更高，但无统计学意义。更高的腰高比（作为不包含体重的指标示例）也与全因死亡和心血管死亡风险更高相关（最高五分位数与最低五分位数相比的HR：全因死亡：HR 2.11，95%CI 1.53-2.92；心血管死亡：HR 2.17，95%CI 1.49-3.15）。
在非缺血性HFrEF患者中，肥胖程度越高与长期死亡率越高之间存在明确关联。
ClinicalTrials.gov NCT00542945。
