The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF

Savji, Nazir; Meijers, Wouter C.; Bartz, Traci M.; Bhambhani, Vijeta; Cushman, Mary; Nayor, Matthew; Kizer, Jorge R.; Sarma, Amy; Blaha, Michael J.; Gansevoort, Ron T.; Gardin, Julius M.; Hillege, Hans L.; Ji, Fei; Kop, Willem J.; Lau, Emily S.; Lee, Douglas S.; Sadreyev, Ruslan I.; Gilst, Wiek H. van; Wang, Thomas J.; Zanni, Markella V.; Vasan, Ramachandran S.; Allen, Norrina B.; Psaty, Bruce M.; Harst, Pim van der; Levy, Daniel; Larson, Martin G.; Shah, Sanjiv J.; Boer, Rudolf A. de; Gottdiener, John S.; Ho, Jennifer E.

doi:10.1016/j.jchf.2018.05.018

Cited by 286 publications

(228 citation statements)

References 35 publications

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“…Obesity is more common in women with HF and may be a stronger risk factor for HF with preserved ejection fraction than HF with reduced ejection fraction in women. 23 Still, pre-transplant BMI >35 m/kg 2 is associated with longer wait times and an increase in morbidity and mortality post-transplant. 24,25 Thus, on the basis of these data and published guidelines, our program requires BMI ≤35 m/kg 2 for HT listing 13 .…”

Section: Discussionmentioning

confidence: 99%

“…[28][29][30] Even recent trials examining shared decision making for DT LVAD have included predominantly male subjects. 23,31 Newer, smaller profile continuous-flow LVADs are easily implanted into women with small body size compared to older systems. Data from large US and European LVAD registries confirm that women have a higher risk of early mortality after LVAD implantation and experience higher rates of adverse events including major bleeding, right ventricular failure, and stroke.…”

Section: Discussionmentioning

confidence: 99%

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Sex differences in eligibility for advanced heart failure therapies

Steinberg

Nayak

O'Connell

et al. 2020

Clinical Transplantation

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Objectives:We investigated sex-based differences in eligibility for and outcomes after receipt of advanced heart failure (HF) therapies.Background: Although women are more likely to die from HF than men, registry data suggest that women are less likely to receive heart transplant (HT) or left ventricular assist device (LVAD) for largely unknown reasons. Methods:We performed a single-center retrospective cohort study of patients evaluated for advanced HF therapies from 2012 to 2016. Logistic regression was used to determine the association of sex with eligibility for HT/LVAD. Competing risks and Kaplan-Meier analysis were used to examine survival. Results:Of 569 patients (31% women) evaluated, 223 (39.2%) were listed for HT and 81 (14.2%) received destination (DT) LVAD. Women were less likely to be listed for HT (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21-0.61; P < .0001), based on allosensitization (P < .0001) and obesity (P = .02). Women were more likely to receive DT LVAD (adjusted OR 2.29, 95% CI 1.23-4.29; P = .01). Survival was similar between men and women regardless of whether they received HT and DT LVAD or were ineligible for therapy. Conclusion:Women are less likely to be HT candidates, but more likely to receive DT LVAD. K E Y W O R D Sdisparities, heart failure, heart transplant, left ventricular assist device, women

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sex differences in eligibility for advanced heart failure therapies

Steinberg

Nayak

O'Connell

et al. 2020

Clinical Transplantation

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show abstract

“…Others have reported strong associations between obesity and related cardiometabolic traits, including insulin resistance, fasting glucose and blood pressure and HF with preserved ejection fraction, especially in women . Impaired skeletal muscle oxidative metabolism may also contribute to limitations in functional capacity of patients with HF and preserved ejection fraction .…”

Section: Discussionmentioning

confidence: 99%

Cardiorespiratory fitness, body mass index and heart failure incidence

Kokkinos

Faselis

Franklin

et al. 2019

European J of Heart Fail

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Aims Obesity is associated with increased risk of heart failure (HF). This risk may be modulated by improved cardiorespiratory fitness (CRF) as CRF is associated with favourable health outcomes. Thus, we assessed the interaction between body mass index (BMI), CRF and HF. Methods and results Cardiorespiratory fitness and BMI were assessed in 20 254 US male veterans (mean age 58.0 ± 11.3 years), who completed a maximal exercise treadmill test between 1987 and 2017. All had no evidence of ischaemia or HF prior to the exercise test. They were classified based on age‐stratified quartiles of peak metabolic equivalents (METs) achieved as: least‐fit (4.5 ± 1.3), low‐fit (6.7 ± 1.3), moderate‐fit (8.1 ± 1.1), and high‐fit (11.2 ± 2.4); and according to BMI as normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (≥ 30.0 kg/m2). During a median follow‐up of 13.4 years, there were 2979 HF events (10.8 events/1000 person‐years). HF risk was significantly higher in the obese category [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.10–1.36; P < 0.001], but was no longer significant after further adjustment for METs. When compared to the least‐fit, HF risk declined progressively with increased CRF within all BMI categories. The risk was 63% (HR 0.37, 95% CI 0.30–0.47; P < 0.001), 66% (HR 0.37, 95% CI 0.28–0.40; P < 0.001), and 73% (HR 0.27, 95% CI 0.22–0.34; P < 0.001) lower for high‐fit individuals within normal weight, overweight and obese categories, respectively. Conclusions Increased CRF was associated with progressively lower HF risk regardless of BMI, suggesting that the elevated HF risk associated with obesity may be modulated by improved CRF.

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“…HFpEF is a heterogenous syndrome characterized by high filling pressures and diastolic abnormalities in the setting of an LVEF ≥50%, which currently lacks evidence-based therapies to reduce morbidity and mortality [109][110][111]. Higher BMI and insulin resistance increase risk for HFpEF more than HFrEF, and over 80% of patients with HFpEF are also overweight and obese [26,112]. This has resulted in the suggestion of a HFpEF-obesity phenotype, although this is controversial, with the opposing argument being that HFpEF and obesity are comorbid conditions with separate CRF abnormalities [103,104,[113][114][115].…”

Section: Hypocaloric Diets In Hfpefmentioning

confidence: 99%

Lifestyle Interventions with a Focus on Nutritional Strategies to Increase Cardiorespiratory Fitness in Chronic Obstructive Pulmonary Disease, Heart Failure, Obesity, Sarcopenia, and Frailty

et al. 2019

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Cardiorespiratory fitness (CRF) is an independent predictor for all-cause and disease-specific morbidity and mortality. CRF is a modifiable risk factor, and exercise training and increased physical activity, as well as targeted medical therapies, can improve CRF. Although nutrition is a modifiable risk factor for chronic noncommunicable diseases, little is known about the effect of dietary patterns and specific nutrients on modifying CRF. This review focuses specifically on trials that implemented dietary supplementation, modified dietary pattern, or enacted caloric restriction, with and without exercise training interventions, and subsequently measured the effect on peak oxygen consumption (VO 2 ) or surrogate measures of CRF and functional capacity. Populations selected for this review are those recognized to have a reduced CRF, such as chronic obstructive pulmonary disease, heart failure, obesity, sarcopenia, and frailty. We then summarize the state of existing knowledge and explore future directions of study in disease states recently recognized to have an abnormal CRF.

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The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF

Abstract: Obesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.

Cited by 286 publications

References 35 publications

Sex differences in eligibility for advanced heart failure therapies

Sex differences in eligibility for advanced heart failure therapies

Cardiorespiratory fitness, body mass index and heart failure incidence

Lifestyle Interventions with a Focus on Nutritional Strategies to Increase Cardiorespiratory Fitness in Chronic Obstructive Pulmonary Disease, Heart Failure, Obesity, Sarcopenia, and Frailty

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