State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology Qilu Hospital of Shandong University Jinan China.
J Am Heart Assoc. 2024 Nov 19;13(22):e035430. doi: 10.1161/JAHA.124.035430. Epub 2024 Nov 4.
There is limited study that illuminates the relationship between obesity indices and prognosis in patients with heart failure with preserved ejection fraction, nor has it been examined whether the obesity paradox persists when using these metrics.
This study is a post hoc analysis of data from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. A total of 3114 individuals were included in our final analysis, and a total of 481 (15.4%) all-cause deaths, and 389 (12.5%) heart failure hospitalizations were recorded. In a multivariable Cox regression model, compared with patients with a body mass index (BMI) <24.9 kg/m, those with a BMI of 25.0-29.9, 30.0-34.9, and 35-39.9 kg/m were associated with a decreased risk of all-cause death, with hazard ratio (95% CI) of 0.59 (0.45-0.78), 0.61 (0.46-0.82), and 0.66 (0.47-0.92), respectively. Conversely, patients with a BMI ≥40 kg/m showed an increased risk of heart failure hospitalization, compared with BMI <24.9 kg/m. Furthermore, patients in the highest quintile of obesity indices exhibited a significantly elevated hazard ratio for both all-cause death and heart failure hospitalization, compared with the lowest quintile.
An elevated BMI over a certain range was associated with a reduced risk of all-cause death in heart failure with preserved ejection fraction, displaying a U-shaped relationship, with no mortality reduction observed in cases of extreme obesity. In contrast, higher values of novel obesity indices were positively correlated with all-cause death and heart failure hospitalization without the obesity paradox.
目前，关于肥胖指数与射血分数保留的心力衰竭患者预后之间的关系，研究甚少，也尚未探讨在使用这些指标时肥胖悖论是否仍然存在。
本研究是对 TOPCAT（醛固酮拮抗剂治疗射血分数保留的心力衰竭）试验数据的事后分析。我们的最终分析共纳入了 3114 名患者，共有 481 名（15.4%）发生全因死亡，389 名（12.5%）发生心力衰竭住院。在多变量 Cox 回归模型中，与 BMI<24.9kg/m2 的患者相比，BMI 为 25.0-29.9kg/m2、30.0-34.9kg/m2 和 35-39.9kg/m2 的患者全因死亡风险降低，风险比（95%CI）分别为 0.59（0.45-0.78）、0.61（0.46-0.82）和 0.66（0.47-0.92）。相反，BMI≥40kg/m2 的患者心力衰竭住院风险增加，与 BMI<24.9kg/m2 相比。此外，与最低五分位相比，肥胖指数最高五分位的患者全因死亡和心力衰竭住院的风险比显著升高。
一定范围内的 BMI 升高与射血分数保留的心力衰竭患者的全因死亡风险降低相关，呈 U 型关系，在极度肥胖的情况下没有观察到死亡率降低。相反，新型肥胖指数的较高值与全因死亡和心力衰竭住院呈正相关，不存在肥胖悖论。
