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Review
. 2019 Feb;108(2):119-132.
doi: 10.1007/s00392-018-1302-7. Epub 2018 Jun 27.

Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose-response meta-analysis

Jufen Zhang  1 , Aine Begley  2 , Ruth Jackson  2 , Michael Harrison  2 , Pierpaolo Pellicori  3 , Andrew L Clark  4 , John G F Cleland  3
Affiliations
Free article
Review

Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose-response meta-analysis

Jufen Zhang et al. Clin Res Cardiol. 2019 Feb.
Free article

Abstract

Background: For patients with heart failure, there is an inverse relation between body mass index (BMI) and mortality, sometimes called the obesity-paradox. However, the relationship might be either U- or J-shaped and might differ between patients with reduced (HFrEF) or preserved left ventricular ejection fraction (HFpEF). We sought to investigate this further in a dose-response meta-analysis of published studies.

Methods: PubMed and Embase from June 1980 to April 2017 were searched for prospective cohort studies evaluating associations between BMI and all-cause mortality in patients with HFrEF (LVEF < 40%) or HFpEF (LVEF ≥ 50%). Summary estimated effect sizes were obtained by using a random-effects model. Potential non-linear relationships were evaluated by using random-effects restricted cubic spline models.

Results: Ten studies were identified that included 96,424 patients of whom 59,263 had HFpEF (mean age 68 years of whom 38% were women) and 37,161 had HFrEF (mean age 60 years of whom 17% were women). For patients with HFpEF, the summary hazard ratio (HR) for all-cause mortality was: 0.93 (95% CI 0.89-0.97) per 5 units increase in BMI (I2 = 75.8%, p for heterogeneity = 0.01 and Begg's test, p = 1.0, Egger's test, p = 0.29) but the association was U-shaped (p for non-linearity < 0.01) with the nadir of risk at a BMI of 32-33 kg/m2. For patients with HFrEF, the summary HR for all-cause mortality was: 0.96 (95% CI 0.92-0.99) (I2 = 95%, p for heterogeneity < 0.001 and Begg's test, p = 0.45, Egger's test, p = 0.01). The relationship was also U-shaped (p < 0.01), although 'flatter' than for HFpEF, with the nadir at a BMI of 33 kg/m2.

Conclusions: For patients with heart failure, the relation between BMI and mortality is U-shaped with a similar nadir of risk for HFpEF and HFrEF at a BMI of 32-33 kg/m2. Whether interventions that alter weight in either direction can alter risk is unknown.

Keywords: BMI; Dose–response meta-analysis; HFpEF; HFrEF; Mortality.

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References

    1. JAMA. 2000 Apr 19;283(15):2008-12 - PubMed
    1. J Am Coll Cardiol. 2000 Dec;36(7):2126-31 - PubMed
    1. J Am Coll Cardiol. 2001 Sep;38(3):789-95 - PubMed
    1. Stat Med. 2002 Jun 15;21(11):1539-58 - PubMed
    1. Arch Intern Med. 2005 Jan 10;165(1):55-61 - PubMed

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