CLINICAL STUDY: HEART FAILURE
The relationship between obesity and mortality in patients with heart failure
Tamara B. Horwich, MD*,
Gregg C. Fonarow, MD, FACC ,
Michele A. Hamilton, MD, FACC,
W. Robb MacLellan, MD, FACC,
Mary A. Woo, DNSc and
Jan H. Tillisch, MD*
* Department of Medicine, University of California at Los Angeles Medical Center, Los Angeles, California, USA
Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California at Los Angeles Medical Center, Los Angeles, California, USA
School of Nursing, University of California at Los Angeles Medical Center, Los Angeles, California, USA
Manuscript received February 1, 2001;
revised manuscript received May 16, 2001,
accepted June 4, 2001.
Reprint requests and correspondence: Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, 47-123 CHS, 10833 Le Conte Avenue, Los Angeles, California 90095-1679
gfonarow{at}mednet.ucla.edu
OBJECTIVES
The study aimed to evaluate the role of obesity in the prognosis of patients with heart failure (HF).
BACKGROUND
Previous reports link obesity to the development of HF. However, the impact of obesity in patients with established HF has not been studied.
METHODS
We analyzed 1,203 patients with advanced HF followed in a comprehensive HF management program. The patients were subclassified into categories of body mass index (BMI) defined as: underweight BMI <20.7 (n = 164), recommended BMI 20.7 to 27.7 (n = 692), overweight BMI 27.8 to 31 (n = 168) and obese BMI >31 (n = 179). This sample size allows the detection of small effects (0.02), with a power of 0.80 and an alpha level of 0.05 for comparing one-year survival between BMI groups.
RESULTS
The four BMI groups had similar profiles in terms of ejection fraction (mean 0.22), sodium, creatinine and smoking. The obese and overweight groups had significantly higher rates of hypertension and diabetes, as well as higher levels of cholesterol, triglycerides and low density lipoprotein cholesterol. The four BMI groups had similar survival rates. Ejection fraction, HF etiology and angiotensin-converting enzyme inhibitor use predicted survival on univariate analysis (p < 0.01), although BMI did not. On multivariate analysis, cardiopulmonary exercise tests, pulmonary capillary wedge pressure and serum sodium were strong predictors of survival (p < 0.05). Higher BMI was not a risk factor for increased mortality, but was associated with a trend toward improved survival.
CONCLUSIONS
In a large cohort of patients with advanced HF of multiple etiologies, obesity is not associated with increased mortality and may confer a more favorable prognosis. Further studies need to delineate whether weight loss promotion in medically optimized patients with HF is a worthwhile therapeutic goal.
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Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | BMI | = body mass index | | BP | = blood pressure | | LV | = left ventricle, left ventricular | | HF | = heart failure | | LVEDD | = left ventricular end-diastolic dimension | | LVEF | = left ventricular ejection fraction | | PA | = pulmonary artery | | PCWP | = pulmonary capillary wedge pressure | | PIBW | = percent ideal body weight | | TNF-alpha | = tumor necrosis factor-alpha |  O2 | = oxygen consumption |
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G. C. Fonarow, T. B. Horwich, M. A. Hamilton, W. R. MacLellan, and J. H. Tillisch
Obesity, weight reduction and survival in heart failure: Reply
J. Am. Coll. Cardiol.,
May 1, 2002;
39(9):
1563 - 1564.
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