Body Mass Index and Mortality in Acutely Decompensated Heart Failure Across the World
Body Mass Index and Mortality in Acutely Decompensated Heart Failure Across the World
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DOI：
10.1016/j.jacc.2013.09.072
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发表时间：
2014-03-04
影响因子：
24
通讯作者：
Mebazaa, Alexandre
中科院分区：
文献类型：
--
作者：
Shah, Ravi;Gayat, Etienne;Mebazaa, Alexandre
目的探讨体重指数(BMI)与心力衰竭(HF)死亡率之间的关系，并明确BMI在心力衰竭(HF)发病风险中的差异性。背景肥胖与心力衰竭的发病相关，但与慢性心力衰竭患者预后的改善有矛盾关系。方法对4大洲12个前瞻性观察队列中6,142例急性失代偿性心衰患者进行研究。主要结果是全因死亡率。COX比例风险模型和净重分类指数描述了BMI与全因死亡率的关联。结果正常体重患者(BMI 18.5~25 kg/m2)年龄越大，心力衰竭越严重，心脏代谢风险越低。尽管肥胖类别的临床特征在世界范围内是不同的，但在对临床风险进行调整后，较高的BMI仍然与30天和1年死亡率下降相关(30天下降11%；每5公斤/平方米一年下降9%；p<；0.05)。指数入院时获得的体重指数提供了超过当前临床风险标记物的有效的1年风险重新分类(净重新分类指数0.119，p<；0.001)。值得注意的是，体重指数与死亡率的“保护性”关联仅限于年龄较大(75岁；危险比：0.82p 0.006)、心功能降低(射血分数50%；心率：0.85p<；0.001)、无糖尿病(心率：0.86p<；0.001)和新发心衰(心率：0.89p<；0.004)。肥胖悖论仅限于老年人，他们的心脏功能下降，心脏代谢疾病较少，以及新近发病的心衰，提示年龄、心力衰竭的严重性/慢性化和代谢可能解释了肥胖悖论。(C)2014年，由美国心脏病学院基金会
Objectives This study sought to define the relationship between body mass index (BMI) and mortality in heart failure (HF) across the world and to identify specific groups in whom BMI may differentially mediate risk.Background Obesity is associated with incident HF, but it is paradoxically associated with better prognosis during chronic HF.Methods We studied 6,142 patients with acute decompensated HF from 12 prospective observational cohorts followed-up across 4 continents. Primary outcome was all-cause mortality. Cox proportional hazards models and net reclassification index described associations of BMI with all-cause mortality.Results Normal-weight patients (BMI 18.5 to 25 kg/ m2) were older with more advanced HF and lower cardiometabolic risk. Despite worldwide heterogeneity in clinical features across obesity categories, a higher BMI remained associated with decreased 30-day and 1-year mortality (11% decrease at 30 days; 9% decrease at 1 year per 5 kg/ m2; p < 0.05), after adjustment for clinical risk. The BMI obtained at index admission provided effective 1-year risk reclassification beyond current markers of clinical risk (net reclassification index 0.119, p < 0.001). Notably, the "protective" association of BMI with mortality was confined to persons with older age (> 75 years; hazard ratio [HR]: 0.82; p 0.006), decreased cardiac function (ejection fraction < 50%; HR: 0.85; p < 0.001), no diabetes (HR: 0.86; p < 0.001), and de novo HF (HR: 0.89; p 0.004).Conclusions A lower BMI is associated with age, disease severity, and a higher risk of death in acute decompensated HF. The "obesity paradox" is confined to older persons, with decreased cardiac function, less cardiometabolic illness, and recent-onset HF, suggesting that aging, HF severity/chronicity, and metabolism may explain the obesity paradox. (c) 2014 by the American College of Cardiology Foundation