Wang Ping, Zhao Yang, Wang Danni, Wang Boxiang, Liu Hange, Fu Guotao, Tao Ling, Tian Gang
Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China.
Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
ESC Heart Fail. 2025 Feb;12(1):290-303. doi: 10.1002/ehf2.15029. Epub 2024 Sep 17.
This study sought to evaluate the correlation between waist-to-height ratio (WHtR) and heart failure (HF) outcomes across different ejection fraction (EF) categories.
A prospective cohort study was conducted at a comprehensive tertiary hospital in China. The participants were categorized by WHtR and EF quartiles. Outpatient or telephone follow-up occurred every 6 months after the diagnosis of heart failure. The primary endpoint was all-cause mortality at 48 months. Cox proportional hazard regression analyses were employed to evaluate the association between WHtR and all-cause mortality. Among 859 enrolled participants, 545 (63.4%) were male, and the mean age was 65.2 ± 11.1 years. After adjusting for age and sex, WHtR demonstrated a strong correlation with both BMI (correlation = 0.703, P = 0.000) and WHR (correlation = 0.609, P = 0.000). Individuals with a high WHtR (≥0.50) had a higher prevalence of hypertension (56.4% vs. 39.6%) and diabetes (26.5% vs. 13.7%), higher levels of TC (3.61 ± 1.55 vs. 3.36 ± 0.90 mmol/L), TG (1.40 ± 0.81 vs. 1.06 ± 0.59 mmol/L), and LDL-C (2.03 ± 0.85 vs. 1.86 ± 0.76 mmol/L) compared with patients with low WHtR (<0.50). NT-proBNP levels were inversely correlated with EF values in both low and high WHtR groups. A total of 149 (18.9%) patients died at the conclusion of the follow-up period. The incidence of all-cause and cardiovascular death was higher in the low WHtR group compared with the high WHtR group [HRs = 1.83 (1.30-2.58), 1.96 (1.34-2.88), respectively]. There was no significant difference in noncardiovascular mortality or rehospitalization rates between the two groups. Patients with HFrEF/low WHtR exhibited a markedly elevated risk of all-cause mortality [HR = 2.31; (95% CI: 1.24-4.30)], heart failure mortality [HR = 3.52; (95% CI: 2.92-8.80)], and noncardiovascular mortality [HR = 4.59; (95% CI: 1.19-17.76)] compared with patients with HFrEF/high WHtR. WHtR has a negligible effect on the risk of all-cause and cardiovascular mortality in heart failure patients with preserved EFs.
The obesity paradox, as delineated by WHtR, is observed in patients with HFrEF, yet absent in those with HFpEF.
本研究旨在评估不同射血分数（EF）类别中腰高比（WHtR）与心力衰竭（HF）预后之间的相关性。
在中国一家综合性三级医院进行了一项前瞻性队列研究。参与者按WHtR和EF四分位数进行分类。心力衰竭诊断后每6个月进行门诊或电话随访。主要终点是48个月时的全因死亡率。采用Cox比例风险回归分析评估WHtR与全因死亡率之间的关联。在859名登记参与者中，545名（63.4%）为男性，平均年龄为65.2±11.1岁。在调整年龄和性别后，WHtR与BMI（相关性=0.703，P=0.000）和腰臀比（WHR）（相关性=0.609，P=0.000）均显示出强相关性。与低WHtR（<0.50）的患者相比，高WHtR（≥0.50）的个体高血压患病率更高（56.4%对39.6%）、糖尿病患病率更高（26.5%对13.7%），总胆固醇（TC）水平更高（3.61±1.55对3.36±0.90 mmol/L）、甘油三酯（TG）水平更高（1.40±0.81对1.06±0.59 mmol/L）以及低密度脂蛋白胆固醇（LDL-C）水平更高（2.03±0.85对1.86±0.76 mmol/L）。在低WHtR组和高WHtR组中，N末端脑钠肽前体（NT-proBNP）水平均与EF值呈负相关。随访期结束时共有149名（18.9%）患者死亡。低WHtR组的全因和心血管死亡发生率高于高WHtR组[风险比（HRs）分别为1.83（1.30 - 2.58）、1.96（1.34 - 2.88）]。两组间非心血管死亡率或再住院率无显著差异。与射血分数降低的心力衰竭（HFrEF）/高WHtR患者相比，HFrEF/低WHtR患者的全因死亡率[HR = 2.31；（95%置信区间：1.24 - 4.30）]、心力衰竭死亡率[HR = 3.52；（95%置信区间：2.92 - 8.80）]和非心血管死亡率[HR = 4.59；（95%置信区间：1.19 - 17.76）]显著升高。WHtR对射血分数保留的心力衰竭患者的全因和心血管死亡风险影响可忽略不计。
由WHtR所描述的肥胖悖论在HFrEF患者中存在，但在射血分数保留的心力衰竭（HFpEF）患者中不存在。
