Tachibana Takahiro, Kubota Yoshiaki, Nishino Takuya, Kato Katsuhito, Iwade Yoshiki, Hayashi Daisuke, Watanabe Yukihiro, Miyachi Hideki, Tara Shuhei, Asai Kuniya
Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Department of Health Care Administration, Nippon Medical School, Tokyo, Japan.
Heart Vessels. 2025 Sep 17. doi: 10.1007/s00380-025-02597-5.
Obesity is an independent risk factor for heart failure (HF) onset; however, weight loss is an independent poor prognostic factor in patients with HF. According to the obesity paradox, higher body weight is associated with better prognosis in these patients. This retrospective cohort study investigated the obesity paradox in super-elderly, understudied patients (aged ≥ 85 years) with HF and examined its impact on all-cause mortality. We included patients hospitalized for HF between April 2015 and March 2023. Participants were divided into four age groups: Groups A (< 65 years), B (65-74 years), C (75-84 years, elderly), and D (≥ 85 years, super-elderly). The primary endpoint was the 1-year all-cause mortality rate after discharge. The secondary endpoints included cardiac and non-cardiac death rates and all-cause mortality rates stratified by left ventricular ejection fraction (LVEF). Overall, 3,811 individuals (mean age: 74.3 years, 60.4% men) were included. A trend toward higher all-cause mortality rates associated with underweight (body mass index [BMI] < 18.5 kg/m) was observed in all age groups. Patients with obesity (BMI ≥ 25.0 kg/m) had significantly better survival than other patients. Underweight was associated with a higher cardiac death rate compared with the other weight categories (P = 0.014, 0.039, and 0.022 for groups B, C, and D, respectively). In the analysis stratified by LVEF, underweight was significantly associated with a higher cardiac death rate in patients with HF with preserved LVEF compared with the other weight categories (P < 0.001). The obesity paradox in the super-elderly population was confirmed. It is important to consider BMI in HF management and prognosis.
肥胖是心力衰竭（HF）发病的独立危险因素；然而，体重减轻是HF患者独立的不良预后因素。根据肥胖悖论，较高的体重与这些患者较好的预后相关。这项回顾性队列研究调查了超老年、研究较少的HF患者（年龄≥85岁）中的肥胖悖论，并研究了其对全因死亡率的影响。我们纳入了2015年4月至2023年3月因HF住院的患者。参与者分为四个年龄组：A组（<65岁）、B组（65 - 74岁）、C组（75 - 84岁，老年）和D组（≥85岁，超老年）。主要终点是出院后1年的全因死亡率。次要终点包括心脏和非心脏死亡率以及按左心室射血分数（LVEF）分层的全因死亡率。总体而言，共纳入3811名个体（平均年龄：74.3岁，男性占60.4%）。在所有年龄组中均观察到体重过轻（体重指数[BMI]<18.5 kg/m）与较高的全因死亡率相关的趋势。肥胖患者（BMI≥25.0 kg/m）的生存率明显高于其他患者。与其他体重类别相比，体重过轻与较高的心脏死亡率相关（B组、C组和D组的P值分别为0.014、0.039和0.022）。在按LVEF分层的分析中，与其他体重类别相比，体重过轻与LVEF保留的HF患者较高的心脏死亡率显著相关（P<0.001）。超老年人群中的肥胖悖论得到了证实。在HF管理和预后中考虑BMI很重要。
