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Comparative Study
. 2014 Dec 30;64(25):2743-9.
doi: 10.1016/j.jacc.2014.09.067.

Pre-morbid body mass index and mortality after incident heart failure: the ARIC Study

Umair Khalid  1 , Sameer Ather  2 , Chirag Bavishi  3 , Wenyaw Chan  4 , Laura R Loehr  5 , Lisa M Wruck  6 , Wayne D Rosamond  5 , Patricia P Chang  7 , Joe Coresh  8 , Salim S Virani  9 , Vijay Nambi  10 , Biykem Bozkurt  9 , Christie M Ballantyne  1 , Anita Deswal  11
Affiliations
Comparative Study

Pre-morbid body mass index and mortality after incident heart failure: the ARIC Study

Umair Khalid et al. J Am Coll Cardiol. .

Abstract

Background: Although obesity is an independent risk factor for heart failure (HF), once HF is established, obesity is associated with lower mortality. It is unclear if the weight loss due to advanced HF leads to this paradoxical finding.

Objectives: This study sought to evaluate the prognostic impact of pre-morbid obesity in patients with HF.

Methods: In the ARIC (Atherosclerosis Risk In Communities) study, we used body mass index (BMI) measured ≥6 months before incident HF (pre-morbid BMI) to evaluate the association of overweight (BMI 25 to <30 kg/m(2)) and obesity (BMI ≥30 kg/m(2)) compared with normal BMI (18.5 to <25 kg/m(2)) with mortality after incident HF.

Results: Among 1,487 patients with incident HF, 35% were overweight and 47% were obese by pre-morbid BMI measured 4.3 ± 3.1 years before HF diagnosis. Over 10-year follow-up after incident HF, 43% of patients died. After adjustment for demographics and comorbidities, being pre-morbidly overweight (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.58 to 0.90; p = 0.004) or obese (HR: 0.70; 95% CI: 0.56 to 0.87; p = 0.001) had a protective association with survival compared with normal BMI. The protective effect of overweight and obesity was consistent across subgroups on the basis of a history of cancer, smoking, and diabetes.

Conclusions: Our results, for the first time, demonstrate that patients who were overweight or obese before HF development have lower mortality after HF diagnosis compared with normal BMI patients. Thus, weight loss due to advanced HF may not completely explain the protective effect of higher BMI in HF patients.

Keywords: obesity paradox; outcomes; overweight; pre-morbid.

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Conflict of interest statement

Conflict(s) Of Interest/Disclosure(s): None of the authors have any financial or other relations that could lead to a conflict of interest.

Figures

FIGURE 1
FIGURE 1. Adjusted Risk of Mortality Associated with BMI Category
The adjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality risk for the obese and overweight groups compared to the normal-weight group (reference group; HR = 1) are shown on a logarithmic scale for the overall cohort, and for the subgroups stratified by smoking, cancer, and diabetes. The results are consistent across all subgroups.
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Kaplan-Meier Survival Curves in HF Patients by Pre-HF BMI Categories
Survival after the development of heart failure (HF) differed significantly among body mass index (BMI) groups defined by pre-HF BMI. The overweight and obese patients had better survival compared with the normal-weight group.
See this image and copyright information in PMC

Comment in

References

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