Abstract 4605: Increased Body Mass Index is Protective against Low Bone Mineral Density in Patients with Heart Failure
Patients with heart failure (HF) may be at greater risk for decreased bone mineral density (BMD) than similarly-aged healthy adults due to limited activity and medications. Being overweight or obese may protect against decreased BMD due to greater weight bearing and hormonal differences. However, these assumptions have never been tested. The purposes were to
compare BMD between patients with HF and similarly-aged healthy adults,
compare BMD among normal weight, overweight, and obese patients with HF, and
determine whether body mass index (BMI) is a predictor of BMD in patients with HF.
A total of 119 patients with HF (preserved or non-preserved systolic function, age = 61 ± 12 yrs, 61% NYHA Class III/IV) and 58 community-dwelling older adults free of cardiovascular disease (age = 70 ± 7 yrs) underwent total body dual-energy x-ray absorptiometry scans. Bone mineral density Z-scores (matched for sex, age, weight, and ethnicity) were compared between patients with HF and healthy elders. Patients with HF were divided into four BMI categories to compare differences in total body BMD by BMI. Multiple linear regression was used to test whether BMI predicted BMD in patients with HF after controlling for age, sex, and NYHA class. Patients with HF had lower total body area BMD Z-scores (0.32 ± 1.20) than the healthy elders (0.88 ± 1.30, p = 0.005). Within the HF group, those with a BMI <25 kg/m2 had lower total body BMD (1.13 ± 0.13 g/cm2) compared to those with BMIs of 25–29.9 kg/m2+ (1.24 ± 0.13 g/cm2, p = 0.002), 30 –34 kg/m2+ (1.23 ± 0.12 g/cm2, p = 0.019), and >34 kg/m2 (1.26 ± 0.13 g/cm2, p <0.001). In the multiple linear regression, BMI was a significant predictor of BMD in patients with HF (β= 0.337, p <0.001), explaining an additional 11% of the variance beyond age, sex, and NYHA class (R2 = 0.40, p <0.001). These results suggest that while HF is associated with decreased BMD, being overweight or obese may be protective against low BMD. This may be another example of better outcomes in overweight and obese patients with HF.
This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).