Abstract 18198: Obesity Paradox in Heart Failure: Impact on death
Introduction: Increasing body mass index (BMI) has been associated with incident heart failure (HF) and studies have shown a protective effect of elevated BMI in chronic HF.
Hypothesis: To evaluate the risk of HF and HF related mortality in obesity and study the impact of purposeful weight loss.
Methods: Pubmed/ Embase was searched with keywords of “heart failure” AND “obesity”. 4637 references were initially identified. After exclusions, 7 studies (n=366228, follow up: 12.3±6.4 years) reporting on the risk of HF in patients with obesity, 14 studies (n=45424; follow up: 4.4±3 years) reporting on HF related mortality in patients with obesity, and 9 studies (n=1111) reporting the impact of purposeful weight loss on cardiac structure and function in obesity were analysed by random-effects meta-analysis.
Results: There was a ‘J curve’ effect of body mass index (BMI) on risk of HF (BMI<20: OR=2.15 [CI 0.59 to 7.85]; BMI 25 to29.9: OR=1.35 [CI 1.07 to 1.70]; BMI>30 to 34.5: OR=2.1 [95% CI 1.36 - 3.24]; BMI>35: OR=1.97[CI 1.12 to 3.47]). Paradoxically an inverse relationship between BMI and HF related mortality (BMI<20: OR=1.37 [1.16 to 1.62]; BMI 25 to29.9: OR=0.77 [CI 0.68 to 0.87]; BMI >30 to 34.5: OR=0.69 [CI 0.57 to 0.85]; BMI>35: OR=0.46 [CI 0.38 to 0.55]) was noted. Purposeful weight loss resulted in reduced left atrial size (SMD -0.48, 95% CI -0.95- to -0.01; p=0.05), left ventricular mass index (-10.9g/m2, 95% CI -15.3 to -6.6; p<0.001) and improved left ventricular systolic (LVEF 3.0%, 95% CI 0.2 to 5.7; p=0.04) and diastolic function (E/A 0.21, 95% CI 0.1 to 0.32; p=<0.001).
Conclusions: BMI has a J curve relationship with HF risk and paradoxically an inverse relationship with HF related mortality. Importantly, purposeful weight reduction results in improvement in cardiac indices suggesting other factors such as cachexia and ‘additional causes’ of HF may be responsible for excessive mortality with normal BMI.
Author Disclosures: S.K. Kumar: None. R. Mahajan: None. D. Lau: None. P. Sanders: Research Grant; Modest; Sorin. Speakers Bureau; Modest; Biosense- Webster, Medtronic, St Jude Medical, Boston Scientific. Consultant/Advisory Board; Modest; Biosense-Webster, Medtronic, St Jude Medical, Boston Scientific, CathRx. Research Grant; Significant; Boston Scientific, St Jude Medical, Medtronic, Biotronik.
- © 2016 by American Heart Association, Inc.