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The relationship between obesity and mortality in patients with heart failure
Open accessAbstract
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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“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]
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“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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Metadata
- 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
- 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)
- 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
- bronze
- doi.org
- 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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