Cassadó-Valls Paula, Enjuanes Cristina, Anguita Manuel, Formiga Francesc, Almenar Luis, Crespo-Leiro María G, Manzano Luis, Muñiz Javier, Chaves José, Hidalgo Encarna, Ramos-Polo Raúl, Yun Sergi, José-Bazán Núria, Moliner Pedro, Comín-Colet Josep
School of Medicine, University of Barcelona, 08097 Barcelona, Spain.
Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
J Clin Med. 2024 Dec 12;13(24):7558. doi: 10.3390/jcm13247558.
Previous studies showed that, paradoxically, obese patients with heart failure (HF) have better clinical outcomes compared to overweight, normal, or underweight patients. Scientific societies emphasize the importance of integrating quality of life (QoL) assessment in cardiovascular care. However, the association between QoL and weight remains understudied. Given the significant correlation between HF survival and QoL, it is essential to assess how obesity impacts patient-reported outcomes in this clinical setting. This cross-sectional multicenter study in 1028 HF patients with reduced ejection fraction (HFrEF) aims to evaluate the association between obesity and QoL, and whether the obesity paradox holds for HF patients regarding QoL. Specific and generic QoL questionnaires were administered alongside clinical parameters like body mass index (BMI) and body adiposity estimator (BAE). Obese compared to non-obese reported worse QoL. In the adjusted linear regression models, neither BMI nor obesity were associated with QoL. Generalized additive models confirmed a strong non-parametric association between BMI, subdomain scores from Kansas City Cardiomyopathy Questionnaire (KCCQ) (OSS = 0.004, CSS = 0.006, TSS = 0.02), and summary measurements of EQ-5D (EQ-5D index = 0.003, visual analogue scale (VAS) = 0.01). In contrast, BAE showed a statistically significant linear relation among QoL (OSS ≤ 0.001, CSS ≤ 0.001, TSS ≤ 0.001) and EQ-5D summary measurements (EQ-5D index ≤ 0.001, VAS ≤ 0.001). : Overall, obese patients have worse QoL; therefore, obesity cannot be considered a protective factor in terms of QoL in established HF.
以往研究表明，矛盾的是，与超重、体重正常或体重过轻的心力衰竭（HF）患者相比，肥胖的HF患者临床结局更好。科学协会强调在心血管护理中纳入生活质量（QoL）评估的重要性。然而，QoL与体重之间的关联仍未得到充分研究。鉴于HF生存率与QoL之间存在显著相关性，评估肥胖在这种临床情况下如何影响患者报告的结局至关重要。这项针对1028例射血分数降低的HF患者（HFrEF）的横断面多中心研究旨在评估肥胖与QoL之间的关联，以及肥胖悖论在HF患者的QoL方面是否成立。除了体重指数（BMI）和身体脂肪估计值（BAE）等临床参数外，还使用了特定和通用的QoL问卷。与非肥胖患者相比，肥胖患者报告的QoL更差。在调整后的线性回归模型中，BMI和肥胖均与QoL无关。广义相加模型证实BMI与堪萨斯城心肌病问卷（KCCQ）的子域评分（总体症状评分（OSS）=0.004，临床症状评分（CSS）=0.006，总分（TSS）=0.02）以及欧洲五维健康量表（EQ-5D）的汇总测量值（EQ-5D指数=0.003，视觉模拟量表（VAS）=0.01）之间存在强烈的非参数关联。相比之下，BAE在QoL（OSS≤0.001，CSS≤0.001，TSS≤0.001）和EQ-5D汇总测量值（EQ-5D指数≤0.001，VAS≤0.001）之间显示出统计学上显著的线性关系。总体而言，肥胖患者的QoL更差；因此，在已确诊的HF中，就QoL而言，肥胖不能被视为一个保护因素。
