Published Online
on July 16, 2007

A more recent version of this article appeared on August 7, 2007

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Submitted on December 12, 2006
Accepted on May 15, 2007

Body Mass Index and Prognosis in Patients With Chronic Heart Failure. Insights From the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Program

Satish Kenchaiah MD, MPH^*, Stuart J. Pocock PhD, Duolao Wang PhD, Peter V. Finn MD, Leonardo A.M. Zornoff MD, PhD, Hicham Skali MD, ScM, Marc A. Pfeffer MD, PhD, Salim Yusuf MD, DPhil, Karl Swedberg MD, PhD, Eric L. Michelson MD, Christopher B. Granger MD, John J.V. McMurray MD, Scott D. Solomon MD, for the CHARM Investigators

From the Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (S.K., P.V.F, L.A.M.Z., H.S., M.A.P, S.D.S); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK (S.J.P, D.W.); McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (S.Y.); Sahlgrenska Academy, Göteborg University, Göteborg, Sweden (K.S.); AstraZeneca LP, Wilmington, Del (E.L.M); Duke University Medical Center, Durham, NC (C.B.G); and University of Glasgow, Glasgow, UK (J.J.V.M).

^* To whom correspondence should be addressed. E-mail: skenchaiah{at}rics.bwh.harvard.edu.

Background--In individuals without known cardiovascular disease, elevated body mass index (BMI) (weight/height²) is associated with an increased risk of death. However, in patients with certain specific chronic diseases, including heart failure, low BMI has been associated with increased mortality.

Methods and Results--We examined the influence of BMI on prognosis using Cox proportional hazards models in 7599 patients (mean age, 65 years; 35% women) with symptomatic heart failure (New York Heart Association class II to IV) and a broad spectrum of left ventricular ejection fractions (mean, 39%) in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. During a median follow-up of 37.7 months, 1831 patients died. After adjustment for potential confounders, compared with patients with BMI between 30 and 34.9, patients in lower BMI categories had a graded increase in the risk of death. The hazard ratios (95% confidence intervals) were 1.22 (1.06 to 1.41), 1.46 (1.24 to 1.71), and 1.69 (1.43 to 2.01) among those with BMI of 25 to 29.9, 22.5 to 24.9, and <22.5, respectively. The increase in risk of death among patients with BMI 35 was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.95 to 1.43). The association between BMI and mortality was not altered by age, smoking status, or left ventricular ejection fraction (P for interaction >0.20). However, lower BMI was associated with a greater risk of all-cause death in patients without edema but not in patients with edema (P for interaction <0.001). Lower BMI was associated with a greater risk of cardiovascular death and noncardiovascular death. Baseline BMI did not influence the risk of hospitalization for worsening heart failure or due to all causes.

Conclusions--In patients with symptomatic heart failure and either reduced or preserved left ventricular systolic function, underweight or low BMI was associated with increased mortality, primarily in patients without evidence of fluid overload (edema).

Key words: heart failure • morbidity • mortality • obesity • prognosis

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