Abstract 18426: Impact of Body Mass Index on Heart Failure With Preserved or Reduced Ejection Fraction: Outcomes According to Race and Ethnicity From Get With The Guidelines-Heart Failure (GWTG-HF) Registry
Introduction: Research supports a J-shaped association between body mass index (BMI) and mortality in patients with coronary artery disease (CAD) regardless of race/ethnicity. However, whether a similar pattern is noted among heart failure (HF) patients is unclear, particularly since black patients are at highest risk for both obesity and heart failure.
Methods: Patients ≥65 years old from the GWTG-HF registry linked to Medicare claims data from 2005-2011, were stratified by preserved (HFpEF) and reduced (HFrEF) ejection fraction HF and categorized by 5 racial/ethnic populations (white, black, Hispanic, Asian, and other). Adjusted-Cox regression assessed the association between BMI and 30-day mortality from live discharge. Restricted cubic splines illustrate the relationship. We used interaction terms to test whether the relationship between BMI and outcomes differed by race/ethnicity.
Results: A total 39647 HF patients were included [white=32434 (81.8%); black=3809 (9.6%); Hispanic=1928 (4.9%); Asian=544 (1.4%);other=932 (2.3%)]. Blacks and Hispanics with HF were more likely class I obese or higher (BMI≥30) than whites or Asians (P <0.0001). Among HFpEF, higher BMI was associated with lower 30 day mortality, up to 30 kg/m2 with little change in risk above 30 (Figure; BMI=30 vs BMI=15 hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.38 - 0.61). A smaller relationship was observed in HFrEF (BMI=30 vs BMI=15 HR 0.64, 95%CI 0.47 - 0.87). There were no significant BMI by race interactions related to mortality (Pall>0.05).
Conclusions: Although black and Hispanic HF patients were more likely to be obese than whites or Asians, higher BMI was associated with lower 30 day mortality in each racial/ethnic group in a manner not consistent with a J-shaped relationship as noted for CAD. Additionally, the differential slope of the association of obesity and mortality among HFpEF and HFrEF patients suggests differing mechanistic factors requiring further exploration.
Author Disclosures: S. Kebede: None. T. Powell-Wiley: None. J. Ngwa: None. D. Lu: None. P.J. Schulte: None. D.L. Bhatt: Consultant/Advisory Board; Modest; GWTG Research Committee. C. Yancy: Consultant/Advisory Board; Modest; GWTG Research Committtee. G.C. Fonarow: Consultant/Advisory Board; Modest; GWTG Research Committtee. M.A. Albert: Consultant/Advisory Board; Modest; AHA Executive Database Committee Chair.
- © 2015 by American Heart Association, Inc.