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Cited by 867Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsCardiovascular Disease and Adiposity

The relationship between obesity and mortality in patients with heart failure

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Horwich, Tamara B, Fonarow, Gregg C, Hamilton, Michele A, MacLellan, W.Robb, Woo, Mary A, Tillisch, Jan H·2001·Journal of the American College of Cardiology
DOI 10.1016/s0735-1097(01)01448-6
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Abstract

Objectives The study aimed to evaluate the role of obesity in the prognosis of patients with heart failure (HF).Background Previous reports link obesity to the development of HF. However, the impact of obesity in patients with established HF has not been studied.Methods We analyzed 1,203 patients with advanced HF followed in a comprehensive HF management program. The patients were subclassified into categories of body mass index (BMI) defined as: underweight BMI <20.7 (n = 164), recommended BMI 20.7 to 27.7 (n = 692), overweight BMI 27.8 to 31 (n = 168) and obese BMI >31 (n = 179). This sample size allows the detection of small effects (0.02), with a power of 0.80 and an alpha level of 0.05 for comparing one-year survival between BMI groups.Results The four BMI groups had similar profiles in terms of ejection fraction (mean 0.22), sodium, creatinine and smoking. The obese and overweight groups had significantly higher rates of hypertension and diabetes, as well as higher levels of cholesterol, triglycerides and low density lipoprotein cholesterol. The four BMI groups had similar survival rates. Ejection fraction, HF etiology and angiotensin-converting enzyme inhibitor use predicted survival on univariate analysis (p < 0.01), although BMI did not. On multivariate analysis, cardiopulmonary exercise tests, pulmonary capillary wedge pressure and serum sodium were strong predictors of survival (p < 0.05). Higher BMI was not a risk factor for increased mortality, but was associated with a trend toward improved survival.Conclusions In a large cohort of patients with advanced HF of multiple etiologies, obesity is not associated with increased mortality and may confer a more favorable prognosis. Further studies need to delineate whether weight loss promotion in medically optimized patients with HF is a worthwhile therapeutic goal.

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  • Some long-term studies show that weight loss in overweight and obesity is associated with increased mortality, and many cardiovascular studies show better prognosis with higher BMI, leading to the suggestion that purposeful weight loss may not be beneficial and may even be detrimental in patients with cardiovascular diseases.

    “Considering that some long-term studies have shown that weight loss in overweight and obesity is associated with increased mortality coupled with many CV studies showing a better prognosis with a higher BMI, it has been suggested that purposeful weight loss may not be beneficial and may even be detrimental in patients with CV diseases (31,66 -68).”

    From Obesity and Cardiovascular Disease (2009) · cites this paper as [31]

  • A growing number of recent reports document a statistically significant survival benefit in obese patients once they have been diagnosed with cardiovascular diseases.

    “While it is widely accepted that obesity increases the risk of developing heart disease, a growing number of recent reports document a statistically significant survival benefit in obese patients once they have been diagnosed with cardiovascular diseases (128, 144, 145, 200, 201, 211, 244).”

    From Cardiac remodeling in obesity (2008) · cites this paper as [145]

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  1. Horwich et al. JACC Vol. 38, No. 3, 2001 Obesity and Heart Failure Mortality September 2001:789-95

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Authors
Horwich, T. B., Fonarow, G. C., Hamilton, M. A., MacLellan, W. R., Woo, M. A., & Tillisch, J. H.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Fonarow, Gregg C
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2001-09
Volume
38
Issue
3
Pages
789-795
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/s0735-1097(01)01448-6
OpenAlex
W2053715742
Cited by
867
References
30
Citations by year
2026: 20 · 2025: 32 · 2024: 32 · 2023: 36 · 2022: 33 · 2021: 33 · 2020: 38 · 2019: 37 · 2018: 41 · 2017: 64 · 2016: 44 · 2015: 25 · 2014: 47 · 2013: 39 · 2012: 39
FWCI
10.97
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
Keywords
obesity, heart failure, mortality, body mass index, prognosis, survival, cardiopulmonary exercise testing, pulmonary capillary wedge pressure, serum sodium, weight loss, advanced heart failure
MeSH terms
Adult, Exercise Test, Female, Heart Failure, Hemodynamics, Humans, Male, Middle Aged, Obesity, Prognosis, Pulmonary Wedge Pressure, Regression Analysis, Body Mass Index

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