Body composition and prognosis in chronic systolic heart failure: the obesity paradox

Lavie, Carl J.; Osman, Ahmed; Milani, Richard V.; Mehra, Mandeep R.

doi:10.1016/s0002-9149(03)00031-6

Cited by 431 publications

(233 citation statements)

References 19 publications

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“…Thus, the results of our study could not confirm the obesity paradox that has been reported in several other studies in those with CAD,28, 29, 30, 31, 32 heart failure,33, 34, 35, 36 and atrial fibrillation 37. The obesity paradox was addressed in a large meta‐analysis of patients with CAD, where it was observed that subjects with a low BMI had an increased relative risk for total mortality and cardiovascular mortality, whereas obese patients had no increased risk or even a lower risk for total mortality or cardiovascular mortality 3.…”

Section: Discussioncontrasting

confidence: 97%

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Medina‐Inojosa

Somers

Thomas

et al. 2018

JAHA

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BackgroundPrognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat‐free mass is associated with better prognosis.Methods and ResultsWe included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow‐up was performed using a record linkage system. Patients were classified in sex‐specific quartiles of BF% and fat‐free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow‐up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30–2.77; P=0.0008). In contrast, fat‐free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat‐free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35–0.82; P=0.004), when compared with those in the first quartile.ConclusionsIn patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat‐free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.

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Section: Discussioncontrasting

confidence: 97%

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Medina‐Inojosa

Somers

Thomas

et al. 2018

JAHA

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“…In this study, clinical events increased by 13% for every 1% absolute reduction in body fat. BMI and total body fat were also independently predictive of event‐free survival 39. The existence of obesity paradox in chronic stable HF has been described extensively in the literature 5, 38, 40, 41…”

Section: Obesity Paradox In Chronic Stable and Acute Decompensated Hementioning

confidence: 86%

Obesity paradox in heart failure: a heavy matter

et al. 2016

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Obesity and heart failure are two of the leading causes of morbidity and mortality in the world. The relationship between obesity and cardiovascular diseases is complex and not fully understood. While the risk of developing heart failure has been shown to be higher in patients who are obese, there is a survival advantage for obese and overweight patients compared with normal weight or low weight patients. This phenomenon was first described by Horwich et al. and was subsequently confirmed in other large trials. The advantage exists irrespective of the type, aetiology, or stage of heart failure. Patients with morbid obesity (body mass index >40 kg/m2), however, do not have the same survival advantage of their obese counterparts. There are several alternative indices of obesity available that may be more accurate than body mass index. The role of weight loss in patients with heart failure is unclear; thus, providing sound clinical advice to patients remains difficult. Future prospective trials designed to evaluate the link between obesity and heart failure will help us understand more fully this complex relationship.

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“…Although many have been surprised by data suggesting that modest obesity is protective in patients with heart failure, both MO and heart failure markedly reduce functional capacity. 6,7 Anecdotally, patients with the combination of these 2 conditions have severe functional limitation and poor survival. In addition, the presence of advanced heart failure makes weight loss by conventional means nearly impossible for obese patients.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure

Ramani

McCloskey

Ramanathan

et al. 2008

Clinical Cardiology

107

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Background: Morbid obesity (MO) is a risk factor for congestive heart failure (CHF). The presence of MO impairs functional status and disqualifies patients for cardiac transplantation. Bariatric surgery (BAS) is a frontline, durable treatment for MO; however, the safety and efficacy of BAS in advanced CHF is unknown. Hypothesis: We hypothesized that by utilizing a coordinated approach between an experienced surgical team and heart failure specialists, BAS is safe in patients with advanced systolic CHF and results in favorable outcomes. Methods: We performed a retrospective chart review of 12 patients with MO (body mass index [BMI] 53±7 kg/m 2 ) and systolic CHF (left ventricular ejection fraction [LVEF] 22±7%, New York Heart Association [NYHA] class 2.9±0.7) who underwent BAS, and then compared outcomes with 10 matched controls (BMI 47.2±3.6 kg/m 2 , LVEF 24±7%, and NYHA class 2.4±0.7) who were given diet and exercise counseling. Results: At 1 y, hospital readmission in BAS patients was significantly lower than controls (0.4±0.8 versus 2.5±2.6, p = 0.04); LVEF improved significantly in BAS patients (35±15%, p = 0.005), but not in controls (29±14%, p = not significant [NS]). The NYHA class improved in BAS patients (2.3±0.5, p = 0.02), but deteriorated in controls (3.3±0.9, p = 0.02). One BAS patient was successfully transplanted, and another listed for transplantation. Conclusions: Bariatric surgery is safe and effective in patients with MO and severe systolic CHF, and should be considered in patients who have failed conventional therapy to improve clinical status.

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Body composition and prognosis in chronic systolic heart failure: the obesity paradox

Cited by 431 publications

References 19 publications

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Obesity paradox in heart failure: a heavy matter

Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure

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