Obesity and the paradox of mortality and heart failure hospitalization in heart failure with preserved ejection fraction
Obesity and the paradox of mortality and heart failure hospitalization in heart failure with preserved ejection fraction
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DOI：
10.1038/s41366-020-0563-1
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发表时间：
2020-06-01
影响因子：
4.9
通讯作者：
Deswal, Anita
中科院分区：
文献类型：
--
作者：
Mandviwala, Taher M.;Basra, Sukhdeep S.;Deswal, Anita
背景 关于肥胖与射血分数保留的心力衰竭 (HFpEF) 患者的住院和死亡率之间的关系，特别是在现实世界的门诊环境中，数据有限。我们假设，射血分数保留的动态心力衰竭患者增加体重指数（BMI）将对这些患者产生保护作用，从而降低死亡率和住院率。方法 我们对全国 153 个退伍军人事务部医疗中心的 2501 名流动 HFpEF 患者进行为期 2 年的随访，研究了 BMI 与全因死亡率、心力衰竭 (HF) 住院时间和全因住院时间之间的关系。结果 与正常BMI相比，超重（HR 0.72；95% CI 0.57-0.91）、肥胖I级（HR 0.59；95% CI 0.45-0.77）、肥胖II级（HR 0.56；95% CI 0.40-0.77）、肥胖III级（HR 0.53；95% CI 0.40-0.77） 0.36-0.77）与人口统计和合并症调整后生存率的提高相关。相比之下，心力衰竭住院时间呈反比关系，与正常体重指数相比，随着BMI增加，心力衰竭住院时间缩短；超重（调整后HR 1.30；95% CI 0.88-1.90）、肥胖I级（HR 1.57；95% CI 1.05-2.34）、肥胖II级（HR 1.79；95% CI 1.15-2.78）和肥胖III级（HR 1.96；95% CI 1.23-3.12）。然而，不同体重指数组的首次全因住院时间没有显着差异。结论 在一个大型的全国动态 HFpEF 队列中，尽管存在与生存相关的肥胖悖论，但 BMI 的增加与 HF 住院风险的增加以及类似的全因住院风险独立相关。未来需要进行更长期的前瞻性试验，评估减肥对严重肥胖和 HFpEF 患者发病率和死亡率的安全性和有效性。
Background Limited data exist on the association of obesity with both hospitalization and mortality in patients with heart failure with preserved ejection fraction (HFpEF), especially in the real-world ambulatory setting. We hypothesized that increasing body-mass index (BMI) in ambulatory heart failure with preserved ejection fraction would have a protective effect on these patients leading to decreased mortality and hospitalizations. Methods We studied the relationship between BMI and the time to all-cause mortality, time to heart failure (HF) hospitalization, and time to all-cause hospitalization over a 2-year follow-up in a national cohort of 2501 ambulatory HFpEF patients at 153 Veterans Affairs medical centers. Results Compared with normal BMI, overweight (HR 0.72; 95% CI 0.57-0.91), obesity class I (HR 0.59; 95% CI 0.45-0.77), obesity class II (HR 0.56; 95% CI 0.40-0.77), and obesity class III (HR 0.53; 95% CI 0.36-0.77) were associated with improved survival after adjustment for demographics and comorbidities. In contrast, the time to HF hospitalization showed an inverse relationship, with shorter time to HF hospitalization with increasing BMI compared with normal BMI; overweight (adjusted HR 1.30; 95% CI 0.88-1.90), obesity class I (HR 1.57; 95% CI 1.05-2.34), obesity class II (HR 1.79; 95% CI 1.15-2.78), and obesity class III (HR 1.96; 95% CI 1.23-3.12). However, time to first all-cause hospitalization was not significantly different by BMI groups. Conclusions In a large, national ambulatory HFpEF cohort, despite the presence of the obesity paradox with respect to survival, increasing BMI was independently associated with an increased risk of HF hospitalization and similar risk of all-cause hospitalization. Future longer-term prospective trials evaluating the safety and efficacy of weight loss on morbidity and mortality, in patients with severe obesity and HFpEF are needed.