Abstract 15840: Obesity Paradox in Heart Failure: Not All Cardiac Cachexia
Introduction: Although obesity is an independent risk factor for development of heart failure (HF), it is associated with lower mortality in prevalent HF. It is unclear if weight loss due to HF (cardiac cachexia) leads to this “obesity paradox” or whether obesity prior to the development of HF is also protective. Accordingly, we examined the prognostic impact of preexisting obesity prior to the incident HF hospitalization.
Methods: We used the Atherosclerosis Risk in Communities (ARIC) study cohort (black and white men and women, aged 45-64 years, from 4 US communities) without a diagnosis of HF at the first study visit (n = 14,399). We examined 3 categories of BMI (normal weight: 18.5-24.99 kg/m2; overweight: 25-29.99; obese: ≥ 30) measured at the last 1 of 4 ARIC study visits at least 6 months (mean 4.3 + 3.1 years) prior to incident HF hospitalization (ICD code ‘428’). The outcome was time to death within 5 years after the HF hospitalization, and was analyzed with Cox proportional hazards models.
Results: 1488 participants with incident HF hospitalizations constituted the study group (18% normal weight, 35% overweight, 47% obese). Compared to normal weight, overweight or obese HF cohort participants were significantly younger, less likely to be cigarette smokers or have health insurance, but had higher prevalence of diabetes and hypertension. KM survival curves showed survival differences between the BMI groups (Figure ). After adjustment for demographics, comorbidities and duration between BMI measurement and incident HF hospitalization, overweight (HR 0.76, 95% CI 0.61-0.94; p=0.01) and obese participants (0.62, 95% CI 0.50-0.78; p<0.0001), had lower hazard of mortality compared with normal weight HF participants.
Conclusions: Overweight and obese were highly prevalent prior to the first HF hospitalization. Our novel findings suggest that pre-existing overweight or obesity may also be associated with a protective survival effect after development of HF.
- © 2013 by American Heart Association, Inc.