Revisiting the obesity paradox in heart failure: Per cent body fat as predictor of biomarkers and outcome

Abstract

Aims Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)). Methods In an individual patient dataset, BMI was calculated as weight (kg)/height (m) 2 , and PBF through the Jackson–Pollock and Gallagher equations. Results Out of 6468 patients (median 68 years, 78% men, 76% ischaemic heart failure, 90% reduced ejection fraction), 24% died over 2.2 years (1.5–2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4–33.0%) with the Jackson–Pollock equation, and 28.0% (23.8–33.5%) with the Gallagher equation, with an extremely strong correlation ( r = 0.996, p < 0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥ 30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome. Conclusion In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.

Body composition indices and cardiovascular risk in type 2 diabetes. CV biomarkers are not related to body composition

“…To our surprise, the levels of NT-proBNP did not correlate to any of the obesity indices of our patients. As a marker of heart failure it has been extensively studied and showed an inverse relationship with body weight [21,30,31]. The inverse relationship of NT-proBNP with BMI, WC and BF% was confirmed in a few studies [32], although others put more weight on lean mass, not on BF% [21].…”

Tai Chi Improves Coronary Heart Disease Risk by Inactivating MAPK/ERK Pathway through Serum miR‐126

“…Heart rate (HR) >76 bpm is at a higher risk of major adverse cardiovascular in CHD patients after PCI [7], and quality of life (QoL) is often used to assess health status after PCI [8]. Obesity is closely associated with heart failure [9,10] and adipose dysfunction [11][12][13]. Epicardial fat is visceral thoracic fat and known to be related to the presence of dyslipidemia and coronary arterial stenosis in the patients after PCI [14].…”

Obesity paradox in heart failure: A matter of debate

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Nowadays obesity is becoming a global epidemic and public health problem in both children and adults. [1][2][3] It is associated with numerous comorbidities such as cardiovascular diseases (CVDs), including atherosclerotic disease, chronic heart failure (CHF), arterial hypertension, type 2 diabetes, certain cancers and sleep apnoea/ sleep-disordered breathing. Moreover, obesity is an independent risk factor for CVD development.

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“…1,2 Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in CHF patients. 3 Obesity produces an increment in total blood volume and cardiac output that is caused in part by the increased metabolic demand induced by excess body weight. 4,5 For centuries, the development of cachexia has been viewed as a sign of poor prognosis, 6 and the research interest in CHF is still growing.…”