scholarly journals Analyzing the Weight of Evidence on the Obesity Paradox and Heart Failure-Is There a Limit to the Madness?

2013 ◽  
Vol 19 (4) ◽  
pp. 158-159 ◽  
Author(s):  
Carl J. Lavie ◽  
Hector O. Ventura
Keyword(s):  
Heart Failure ◽  
Obesity Paradox ◽  
Weight Of Evidence

The Relation of Body Mass Index to Biochemical Parameters and Profile of Heart Failure

2018 ◽  
Vol 69 (7) ◽  
pp. 1673-1677
Author(s):  
Viviana Aursulesei ◽  
Andrei Manta ◽  
Razan Al Namat ◽  
Monica Hugianu ◽  
Angela Maria Moloce ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Body Mass Index ◽  
Body Mass ◽  
Patient Selection ◽  
Biochemical Parameters ◽  
Obesity Paradox ◽  
Lipid Levels ◽  
Randomized Control ◽  
Selection Parameters

The bidirectional relation between body mass index (BMI) and heart failure (HF) is complex and not fully understood. The obesity paradox phenomena is controversial and related to patient selection, parameters used for defining abnormal weight, characteristics of HF. Our study sustain the importance of controlling risk factors, in particular plasma glucose, lipid levels, as well as hypertension in patients with HF and BMI over 25 kg/m2. Also, in contrast to the randomized control studies our results can only partially support data related to obesity paradox phenomena.

scholarly journals High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katsuhiko Ohori ◽  
Toshiyuki Yano ◽  
Satoshi Katano ◽  
Hidemichi Kouzu ◽  
Suguru Honma ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Fat ◽  
Fat Mass ◽  
Cardiac Event ◽  
Muscle Wasting ◽  
Obesity Paradox ◽  
Percent Body Fat ◽  
Body Fat Mass ◽  
Cardiac Events ◽  
Kaplan Meier

Abstract Background Although high body mass index (BMI) is a risk factor of heart failure (HF), HF patients with a higher BMI had a lower mortality rate than that in HF patients with normal or lower BMI, a phenomenon that has been termed the “obesity paradox”. However, the relationship between body composition, i.e., fat or muscle mass, and clinical outcome in HF remains unclear. Methods We retrospectively analyzed data for 198 consecutive HF patients (76 years of age; males, 49%). Patients who were admitted to our institute for diagnosis and management of HF and received a dual-energy X-ray absorptiometry scan were included regardless of left ventricular ejection fraction (LVEF) categories. Muscle wasting was defined as appendicular skeletal muscle mass index < 7.0 kg/m2 in males and < 5.4 kg/m2 in females. Increased percent body fat mass (increased FM) was defined as percent body fat > 25% in males and > 30% in females. Results The median age of the patients was 76 years (interquartile range [IQR], 67–82 years) and 49% of them were male. The median LVEF was 47% (IQR, 33–63%) and 33% of the patients had heart failure with reduced ejection fraction. Increased FM and muscle wasting were observed in 58 and 67% of the enrolled patients, respectively. During a 180-day follow-up period, 32 patients (16%) had cardiac events defined as cardiac death or readmission by worsening HF or arrhythmia. Kaplan-Meier survival curves showed that patients with increased FM had a lower cardiac event rate than did patients without increased FM (11.4% vs. 22.6%, p = 0.03). Kaplan-Meier curves of cardiac event rates did not differ between patients with and those without muscle wasting (16.5% vs. 15.4%, p = 0.93). In multivariate Cox regression analyses, increased FM was independently associated with lower cardiac event rates (hazard ratio: 0.45, 95% confidence interval: 0.22–0.93) after adjustment for age, sex, diabetes, muscle wasting, and renal function. Conclusions High percent body fat mass is associated with lower risk of short-term cardiac events in HF patients.

scholarly journals The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Emmanuel Aja Oga ◽  
Olabimpe Ruth Eseyin
Keyword(s):  
Heart Failure ◽  
Weight Status ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Conclusive Evidence ◽  
Study Endpoint ◽  
Nyha Classification ◽  
Improved Outcomes ◽  
Observational Cohort

There is scientific consensus that obesity increases the risk of cardiovascular diseases, including heart failure. However, among persons who already have heart failure, outcomes seem to be better in obese persons as compared with lean persons: this has been termed theobesity paradox, the mechanisms of which remain unclear. This study systematically reviewed the evidence of the relationship between heart failure mortality (and survival) and weight status. Search of the PubMed/MEDLINE and EMBASE databases was done according to the PRISMA protocol. The initial search identified 9879 potentially relevant papers, out of which ten studies met the inclusion criteria. One study was a randomized clinical trial and 9 were observational cohort studies: 6 prospective and 3 retrospective studies. All studies used the BMI, WC, or TSF as measure of body fatness and NYHA Classification of Heart Failure and had single outcomes, death, as study endpoint. All studies included in review were longitudinal studies. All ten studies reported improved outcomes for obese heart failure patients as compared with their normal weight counterparts; worse prognosis was demonstrated for extreme obesity (BMI>40 kg/m2). The findings of this review will be of significance in informing the practice of asking obese persons with heart failure to lose weight. However, any such recommendation on weight loss must be consequent upon more conclusive evidence on the mechanisms of the obesity paradox in heart failure and exclusion of collider bias.

Impact of obesity on the clinical outcomes of patients undergoing pacemaker insertion during hospitalization: An analysis of the United States National Inpatient Sample

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Almani ◽  
M Usman ◽  
M Qudrat Ullah ◽  
N Fatima ◽  
M Yousuf ◽  
...  
Keyword(s):  
Heart Failure ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Decompensated Heart Failure ◽  
Obesity Paradox ◽  
Obese Patients ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Secondary Outcomes ◽  
Pacemaker Insertion

Abstract Funding Acknowledgements Type of funding sources: None. 1. Introduction Obesity causes significant cardiovascular morbidity. Nonetheless, there is also evidence supporting obesity paradox particularly in heart failure patients. The impact of obesity on the outcomes of patients undergoing pacemaker insertion is not well studied. 2. Purpose The purpose of this study is to determine if obesity paradox exists for the patients who undergo pacemaker insertion. 3. Methods Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for patients who underwent pacemaker insertion while hospitalized. The patients were divided into two groups based on presence or absence of obesity as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to for analysis. 4. Results Of 408,040 patients who underwent pacemaker insertion, 64185 (15.7%) were obese. The adjusted odds ratio for inpatient mortality for obese patient undergoing pacemaker insertion compared to non-obese patients was 0.65 (95% CI 0.516 – 0.821, p &lt; 0.001). Secondary outcomes are listed in table 1. 5. Conclusion Obese patients who underwent pacemaker insertion had lower inpatient mortality compared to non-obese patients. Also, obese patients undergoing pacemaker insertion were less likely to have cardiac arrest but they were more likely to develop decompensated heart failure and acute renal failure compared to non-obese patients. Outcome Without Obesity, % With Obesity, % aOR (95% CI) p-value* Primary outcome In hospital mortality 10.8 7.0 0.65 (0.516 - 0.821) &lt;0.001* Secondary outcomes Length of stay (days), mean 5.7 6.3 0.031 (-0.105 - 0.168) # 0.654 Total hospital charges (US$), mean 121250 134757 720 (-2307 - 3747) # 0.641 Decompensated heart failure 13.3 19.2 1.53 (1.451 - 1.629) &lt;0.001* Cardiogenic shock 2.3 2.7 1.00 (0.883 - 1.141) 0.954 IABP placement 0.5 0.6 0.98 (0.746 - 1.294) 0.898 Cardiac arrest 4.27 4.30 0.83 (0.753 - 0.920) &lt;0.001* Acute renal failure 20.7 25.4 1.17 (1.112 - 1.231) &lt;0.001* Abbreviations: *; statistically significant, #; adjusted mean difference, aOR: adjusted odds ratio, CI: confidence interval, IABP: Intra-aortic balloon pump.Adjusting factors: Age, race, Charlson comorbidity index, primary insurance, median household income for patient’s zip code, location and teaching status of the admitting hospital, dyslipidemia, chronic obstructive pulmonary disease, hypertension, peripheral vascular disease, diabetes mellitus, chronic kidney disease, liver disease and smoking status. Table 1: Clinical outcomes of hospitalizations for pacemaker insertion based on presence or absence of obesity, analysis of United States National Inpatient Sample from 2016 through 2018.

scholarly journals Obesity Paradox" – another look at the problem of cardiovascular disease

2013 ◽  
Vol 10 (4) ◽  
pp. 3-9
Author(s):  
O V Shpagina ◽  
I Z Bondarenko
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Obesity Paradox ◽  
Developed Countries ◽  
Epidemiologic Studies ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Published Data ◽  
Risk Of Death ◽  
Cardiovascular Prognosis

Major epidemiologic studies over the last century demonstrated that obesity leads to several severe diseases such as diabetes mellitus, hypertension, coronary heart disease, chronic heart failure, cerebrovascular accidents. In developed countries cardiovascular diseases became the main cause of death. In the last 5–6 years some studies showed that people with overweight and obesity of the first degree have a higher life expectancy than people with normal weight. In 2009, the published data showed that the presence of obesity in patients with chronic heart failure does not impair cardiovascular prognosis. Overweight correlates with a decrease in overall mortality by 25%. And in a first degree of obesity the risk of death is reduced by 12%. This phenomenon is called "obesity paradox" and the causes of which are discussed in this review.

Obesity Paradox: Comparison of Heart Failure Patients With and Without Comorbid Diabetes

2017 ◽  
Vol 26 (2) ◽  
pp. 140-148 ◽  
Author(s):  
Kyoung Suk Lee ◽  
Debra K. Moser ◽  
Terry A. Lennie ◽  
Michele M. Pelter ◽  
Thomas Nesbitt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Obesity Paradox ◽  
Heart Failure Patients

Abstract P174: Factors Related to Decreased Readmission within 30 Days for Hispanic Heart Failure Patients

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Hong Seok Lee ◽  
Gerald Pekler ◽  
Fernand Visco ◽  
Savi Mushiyev
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
Central Obesity ◽  
Randomized Study ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Obese Group ◽  
Heart Failure Patients ◽  
Number Of Patients ◽  
Heart Failure Exacerbation

Objective: This study was aimed to relate the obesity paradox to readmission and obesity. The obesity paradox remains controversial in the literature. Obesity has detrimental effects on heart failure, but has been found to be paradoxically associated with improved survival. We hypothesized that readmission in heart failure patients is associated with obesity. Method: We analyzed 732 patients who were admitted for heart failure exacerbation and enrolled in our heart failure program and excluded those who did not follow-up or patients discharged from the cardiology clinic. Patients who were readmitted within 30 days for heart failure exacerbation were investigated. 688 patients who have been followed since 2013 were included. BMI (body mass index) and WC (waist circumference) were classified according to NCEP-ATP III. Results: The number of normal weight (BMI <25kg/m 2 ), overweight (30 kg/m 2 >BMI≥25kg/m 2 ) and obesity (BMI≥30kg/m 2 ) were 35.7%, 35.1% and 29.1%, respectively. Central obesity (WC ≥94 cm for men ,and ≥80 for women) were 62%. The number of patients in our selected populations of HFrEF, HFpEF and HFpEF(i) were 456(67.9%),136(20.2%) and 68(11.9%) respectively. A higher readmission rate had a significantly associated with non-obese (BMI less than 30 kg/m 2) group compared to obese group(BMI more than 30 kg/m 2) in HFpEF patients. There was no significant association between central obesity and readmission. In addition, the absence of diabetes mellitus, an ICD (implantable cardioverter defibrillator), no prior cardiac catheterization and age over 65 were associated with a lower readmission rate. Conclusion: The obesity paradox with BMI applied to our study group. The obese group had a significant association with reduced readmission rate compared to the normal or overweight BMI group in HFpEF. WC was not associated with readmission. Higher BMI may be related to better cardiopulmonary fitness in HFpEF. To apply to clinical practice, a large randomized study should be warranted. Targeted management in different types of heart failure could be associated readmission.

Abstract P302: Lack of Obesity Paradox in 30 Day and Annual Cumulative Acute Decompensated Heart Failure Readmissions

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Ravinder Valadri ◽  
Namrata Singhania ◽  
Deborah Deborah ◽  
Richard English ◽  
LeYu Naing ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Study Cohort ◽  
Data Sets ◽  
Index Hospitalization ◽  
Unplanned Hospitalizations ◽  
End Stage

Background: Recent study demonstrated paradoxical relationship between body mass Index (BMI) and all cause mortality in patients with acute decompensated heart Failure (ADHF), where higher BMI was associated with decreased mortality. We sought to test whether this relationship exists between BMI and ADHF readmissions Methods: Consecutive patients presented to the emergency department from March 2014 to July 2015 with the diagnosis of ADHF were analyzed in a retrospective cohort study. Cohort was grouped in to prespecified BMI categories; normal weight (BMI <26 Kg/m2 ), Over weight (BMI 25-30 Kg/m2 ) and Obese (BMI >30 Kg/m2 and above). Primary endpoints were incidence of 30 day ADHF readmission and time to first ADHF readmission from the index hospitalization. Patients with end stage COPD on home O2, cirrhosis and end stage renal failure on dialysis were excluded. Unplanned hospitalizations due to other cause than ADHF were excluded. ADHF hospitalizations were adjudicated by an independent blinded clinician Results: Cohort (N=188) consisted 51(27.1%) normal weight, 61 (32.4%) over weight and 76 (40.4%) obese patients. Females were 63% (N=119), patients with heart failure with preserved ejection fraction were 47% (N=90), Obese [BMI 31(28-38) Kg/m2; Median (IQR)] patients were younger (median age; 77 years vs 83 years; P=0.002), whereas other covariates were similar between groups. In median follow up of 1.2 years, total 30 day ADHF readmissions were 32 and total ADHF admissions were 214. Incidence of both 30 day and total ADHF readmissions were similar in all 3 BMI categories; ANOVA P=0.18 (30 day ADHF readmissions) and P= 0.62 (total ADHF readmissions). Obesity was neither associated with risk for 30 day readmission; OR=0.64 (CI: 0.20 - 2.0; P= 0.45) nor with the time to first ADHF readmission from the index hospitalization; log rank P=0.5 (Figure 1) Conclusions: Higher BMI is not protective against ADHF readmissions in patients with ADHF. Further studies are needed in larger data sets to validate our findings.

Abstract 2936: Obesity and Mortality in Patients with Heart Failure and Preserved Systolic Function

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
John R Kapoor ◽  
Paul A Heidenreich
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Systolic Function ◽  
Total Mortality ◽  
Obesity Paradox ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Heart Failure Patients ◽  
Objective Evidence

Several large cohort studies document better survival in heart failure patients with decreased left ventricular ejection fraction (EF) and higher body mass index (BMI) compared to those with a lower BMI. It is unclear, though, if this “obesity paradox” applies to heart failure patients with preserved EF or if it extends to the very obese (BMI>35). We followed 1,235 consecutive patients with a prior diagnosis of heart failure and a preserved EF (≥50%) documented on echocardiography at one of three laboratories. We determined adjusted mortality and readmission rates at 1 year following the echocardiogram. Obesity (BMI>30) was noted in 542 patients (44%). The mean age of the cohort was 71 years, but this varied depending on BMI (73 years for BMI<25, 64 years for BMI> 35, p< 0.001). In a subset of patients with complete diastolic indices and LV mass measurements (n=405), 95% had objective evidence of diastolic dysfunction. Age-adjusted all-cause mortality (Figure ) at one year decreased with increasing BMI (31% if BMI < 25, 22% if BMI 25–29, 20% if BMI 30–35 and 19% if BMI>35, p=0.003). In a proportional hazards analysis that adjusted for patient history, demographics and laboratory values, the hazard ratios for total mortality (relative to a normal BMI) were 1.47 (95% CI, 1.06–2.05) for BMI<25, 0.95 (95% CI, 0.64 –1.42) for BMI 30 –35, and 0.83 (95% CI, 0.52–1.31), for BMI >35, p=0.046). Similar findings were noted for the composite endpoint of survival free from heart failure hospitalization. These data suggest that the obesity paradox applies to heart failure patients with preserved systolic function and extends to very obese patients (BMI>35).

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