Guo Fan-Shun, Guo Chen, Dou Jia-Hao, Wang Jun-Xiang, Wu Rui-Yun, Song Shou-Fang, Sun Xue-Lu, Hu Yi-Wei, Wei Jin
Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Clinical Research Center for Endemic Disease of Shaanxi Province, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Front Endocrinol (Lausanne). 2025 Mar 4;16:1430277. doi: 10.3389/fendo.2025.1430277. eCollection 2025.
Obesity, especially abdominal obesity, is more common in patients with heart failure (HF), but body mass index (BMI) cannot accurately describe fat distribution. Several surrogate adiposity markers are available to reflect fat distribution and quantity. The objective of this study was to explore which adiposity marker is most highly correlated with HF prevalence, all-cause mortality and patients' long-term survival.
The National Health and Nutrition Examination Survey (NHANES) database provided all the data for this study. Logistic regression analyses were adopted to compare the association of each surrogate adiposity marker with the prevalence of HF. Cox proportional hazards models and restricted cubic spline (RCS) analysis were employed to assess the association between surrogate adiposity markers and all-cause mortality in HF patients. The ability of surrogate adiposity markers to predict long-term survival in HF patients was assessed using time-dependent receiver operating characteristic (ROC) curves.
46,257 participants (1,366 HF patients) were encompassed in this retrospective study. An area under the receiver operating characteristic curve (AUC) for the prevalence of HF assessed by weight-adjusted-waist index (WWI) was 0.70 (95% CI: 0.69-0.72). During a median follow-up of 70 months, 700 of 1366 HF patients' death were recorded. The hazard ratio (HR) for HF patients' all-cause mortality was 1.33 (95% CI: 1.06-1.66) in the a body shape index (ABSI) quartile 4 group and 1.43 (95% CI: 1.13-1.82) in the WWI quartile 4 group, compared with the lowest quartile group. The AUC for predicting 5-year survival of HF patients using the ABSI was 0.647 (95% CI: 0.61-0.68).
WWI is strongly correlated with the prevalence of HF. In HF patients, those with higher WWI and ABSI tend to higher all-cause mortality. ABSI can predict patients' long-term survival. We recommend the use of WWI and ABSI for assessing obesity in HF patients.
肥胖，尤其是腹型肥胖，在心力衰竭（HF）患者中更为常见，但体重指数（BMI）无法准确描述脂肪分布情况。有几种替代肥胖指标可用于反映脂肪分布和数量。本研究的目的是探讨哪种肥胖指标与HF患病率、全因死亡率及患者长期生存率的相关性最高。
国家健康与营养检查调查（NHANES）数据库为本研究提供了所有数据。采用逻辑回归分析比较各替代肥胖指标与HF患病率之间的关联。采用Cox比例风险模型和受限立方样条（RCS）分析评估替代肥胖指标与HF患者全因死亡率之间的关联。使用时间依赖性受试者工作特征（ROC）曲线评估替代肥胖指标预测HF患者长期生存的能力。
这项回顾性研究纳入了46257名参与者（1366名HF患者）。通过体重调整腰围指数（WWI）评估HF患病率的受试者工作特征曲线下面积（AUC）为0.70（95%置信区间：0.69 - 0.72）。在中位随访70个月期间，记录了1366名HF患者中的700例死亡。与最低四分位组相比，身体形状指数（ABSI）四分位4组中HF患者全因死亡率的风险比（HR）为1.33（95%置信区间：1.06 - 1.66），WWI四分位4组中为1.43（95%置信区间：1.13 - 1.82）。使用ABSI预测HF患者5年生存率的AUC为0.647（95%置信区间：0.61 - 0.68）。
WWI与HF患病率密切相关。在HF患者中，WWI和ABSI较高者全因死亡率往往更高。ABSI可预测患者的长期生存。我们建议使用WWI和ABSI评估HF患者的肥胖情况。
