Mohammed Adil Sarvar, Ahmed Hafeezuddin, Singh Sachin, Munguti Cyrus Mutinda, Subramanian Lakshmi, Srikanth Sashwath, Kodali Lakshmi Sai Meghana, Takagi Maya Asami, Yasmeen Umera, Imtiaz Hassaan, Jain Akhil, Chaudhry Saad, Desai Rupak
Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, USA.
Department of Internal Medicine, DMC Sinai Grace-Detroit Medical Center, Detroit, MI 48235, USA.
J Clin Med. 2025 Aug 4;14(15):5495. doi: 10.3390/jcm14155495.
Clinical outcomes among older adults hospitalized with heart failure with preserved ejection fraction (HFpEF) in the setting of metabolically healthy obesity (MHO) remain insufficiently explored. This study aimed to evaluate whether MHO status is associated with different rates of major adverse cardiac and cerebrovascular events (MACCEs) during HFpEF-related hospitalizations compared to patients without MHO. Data from the 2019 National Inpatient Sample (NIS) database was analyzed using relevant ICD-10 codes to identify HFpEF admissions in older adults. Propensity score matching (1:1) was applied to generate balanced cohorts of patients with and without MHO. Multivariable adjustments were performed to assess primary outcomes, including MACCEs, all-cause mortality (ACM), acute myocardial infarction (AMI), dysrhythmia, cardiac arrest (CA), and stroke. Statistical significance was set at < 0.05. Each MHO cohort included 22,405 patients with a median age of 75 years. The MHO+ group demonstrated a significantly higher risk of dysrhythmia (OR 1.32, 95% CI 1.21-1.43, < 0.001). Interestingly, an "obesity paradox" was observed, as the MHO+ cohort had lower odds of MACCEs (OR 0.70, 95% CI 0.61-0.81, < 0.001), ACM (OR 0.66, 95% CI 0.54-0.82, < 0.001), and AMI (OR 0.71, 95% CI 0.59-0.86, = 0.001) compared to MHO-. No significant differences were found for CA or stroke between the groups. Although the MHO+ group had an elevated risk of dysrhythmia, they exhibited more favorable outcomes in terms of MACCEs, ACM, and AMI-supporting the concept of an "obesity paradox." Further research is needed to better understand the role of MHO as a comorbid condition in patients with HFpEF.
对于射血分数保留的心力衰竭（HFpEF）合并代谢健康型肥胖（MHO）的老年住院患者，其临床结局仍未得到充分研究。本研究旨在评估与无MHO的患者相比，MHO状态是否与HFpEF相关住院期间主要不良心脑血管事件（MACCE）的不同发生率相关。使用相关的ICD-10编码分析了2019年全国住院患者样本（NIS）数据库中的数据，以识别老年患者的HFpEF入院情况。应用倾向评分匹配（1:1）来生成MHO患者和非MHO患者的平衡队列。进行多变量调整以评估主要结局，包括MACCE、全因死亡率（ACM）、急性心肌梗死（AMI）、心律失常、心脏骤停（CA）和中风。设定统计学显著性为<0.05。每个MHO队列包括22,405名患者，中位年龄为75岁。MHO+组的心律失常风险显著更高（OR 1.32，95%CI 1.21-1.43，<0.001）。有趣的是，观察到一种“肥胖悖论”，因为与MHO-组相比，MHO+队列发生MACCE的几率更低（OR 0.70，95%CI 0.61-0.81，<0.001）、ACM（OR 0.66，95%CI 0.54-0.82，<0.001）和AMI（OR 0.71，95%CI 0.59-0.86，=0.001）。两组之间在CA或中风方面未发现显著差异。尽管MHO+组心律失常风险升高，但他们在MACCE、ACM和AMI方面表现出更有利的结局，支持“肥胖悖论”的概念。需要进一步研究以更好地理解MHO作为HFpEF患者合并症的作用。
