Body mass index and prognosis in patients with chronic heart failure - Insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program
Body mass index and prognosis in patients with chronic heart failure - Insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program
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DOI：
10.1161/circulationaha.106.679779
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发表时间：
2007-08-07
期刊：
影响因子：
37.8
通讯作者：
Solomon, Scott D.
中科院分区：
文献类型：
--
作者：
Kenchaiah, Satish;Pocock, Stuart J.;Solomon, Scott D.
背景-在没有已知心血管疾病的个体中，体重指数（BMI）（体重/身高（2））升高与死亡风险增加相关。然而，在某些特定的慢性疾病患者中，包括心力衰竭，低BMI与死亡率增加有关。方法和结果-我们使用考克斯比例风险模型研究了BMI对7599例患者预后的影响（平均年龄65岁; 35%的女性）有症状的心力衰竭（纽约心脏协会II至IV级）和左心室射血分数的广谱坎地沙坦治疗心力衰竭：死亡率和发病率降低评估（CHARM）项目中的平均值为39%。在中位随访37.7个月期间，1831名患者死亡。校正潜在混杂因素后，与BMI在30 - 34.9之间的患者相比，BMI较低的患者死亡风险分级增加。在BMI为25 - 29.9、22.5 - 24.9和< 22.5的人群中，风险比（95%置信区间）分别为1.22（1.06 - 1.41）、1.46（1.24 - 1.71）和1.69（1.43 - 2.01）。BMI >= 35的患者死亡风险增加无统计学意义（风险比，1.17; 95%置信区间，0.95 - 1.43）。BMI和死亡率之间的相关性不受年龄、吸烟状况或左心室射血分数的影响（相互作用P> 0.20）。然而，较低的BMI与无水肿患者的全因死亡风险较高相关，但与水肿患者无关（相互作用P < 0.0001）。较低的BMI与心血管死亡和非心血管死亡的风险较高相关。基线BMI并不影响心衰恶化或由于所有causes.Conclusions住院的风险-在有症状的心衰患者，无论是减少或保留左心室收缩功能，体重不足或低BMI与死亡率增加，主要是在患者没有证据的液体超负荷（水肿）。
Background - In individuals without known cardiovascular disease, elevated body mass index (BMI) (weight/ height(2)) is associated with an increased risk of death. However, in patients with certain specific chronic diseases, including heart failure, low BMI has been associated with increased mortality.Methods and Results - We examined the influence of BMI on prognosis using Cox proportional hazards models in 7599 patients (mean age, 65 years; 35% women) with symptomatic heart failure (New York Heart Association class II to IV) and a broad spectrum of left ventricular ejection fractions (mean, 39%) in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. During a median follow-up of 37.7 months, 1831 patients died. After adjustment for potential confounders, compared with patients with BMI between 30 and 34.9, patients in lower BMI categories had a graded increase in the risk of death. The hazard ratios (95% confidence intervals) were 1.22 (1.06 to 1.41), 1.46 (1.24 to 1.71), and 1.69 (1.43 to 2.01) among those with BMI of 25 to 29.9, 22.5 to 24.9, and < 22.5, respectively. The increase in risk of death among patients with BMI >= 35 was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.95 to 1.43). The association between BMI and mortality was not altered by age, smoking status, or left ventricular ejection fraction (P for interaction > 0.20). However, lower BMI was associated with a greater risk of all-cause death in patients without edema but not in patients with edema (P for interaction < 0.0001). Lower BMI was associated with a greater risk of cardiovascular death and noncardiovascular death. Baseline BMI did not influence the risk of hospitalization for worsening heart failure or due to all causes.Conclusions - In patients with symptomatic heart failure and either reduced or preserved left ventricular systolic function, underweight or low BMI was associated with increased mortality, primarily in patients without evidence of fluid overload (edema).