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(Circulation. 2007;116:588-590.)
© 2007 American Heart Association, Inc.

Editorial

Tipping the Scale

Heart Failure, Body Mass Index, and Prognosis

Stephan von Haehling, MD; Tamara B. Horwich, MD; Gregg C. Fonarow, MD; Stefan D. Anker, MD, PhD

From the Division of Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow Klinikum, Berlin, Germany (S.v.H., S.D.A.), and Ahmanson–UCLA Cardiomyopathy Center, University of California at Los Angeles Medical Center, Los Angeles (T.B.H., G.C.F.).

Correspondence to Professor Stefan D. Anker, Division of Applied Cachexia Research, Department of Cardiology, Charité, Campus Virchow-Klinik, Augustenburger Platz 1, D-13353 Berlin, Germany. E-mail s.anker@cachexia.de

Key Words: Editorials • heart failure • obesity • prognosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Obesity has reached endemic proportions. The World Health Organization has estimated that >1 billion adults are overweight worldwide, and 300 million of them are clinically obese.¹ In the general population up to 60 to 65 years of age, a higher body mass index (BMI) is associated with an increased risk for cardiovascular events and new-onset heart failure (HF). An increasing number of patients with chronic illness are obese. Of patients with chronic HF, >50% are in the overweight or obese categories.² Although it was presumed that obesity would further increase mortality risk in patients with established HF, a number of recent studies have indicated that BMI is actually inversely associated with long-term mortality in chronic HF, the so-called obesity paradox.³

Article p 627

In this issue of Circulation, a retrospective analysis of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) trial program by Kenchaiah et al⁴ on the relationship between BMI and survival and other important clinical end points is reported. The authors analyzed data from all 7599 patients with symptomatic chronic HF who received candesartan (n=3803) or placebo (n=3796) and who were either angiotensin-converting enzyme inhibitor naïve or already treated with such a drug. Patients were in New York Heart Association classes II through IV, and their left ventricular ejection fractions were distributed across a wide range, with a mean value of 39%. All subjects were followed up for a median of 37.7 months. Kenchaiah et al subgrouped the patients according to different . . . [Full Text of this Article]

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