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.

scholarly journals Discordance between Body-Mass Index and Body Adiposity Index in the Classification of Weight Status of Elderly Patients with Stable Coronary Artery Disease

2021 ◽  
Vol 10 (5) ◽  
pp. 943
Author(s):  
Bartosz Hudzik ◽  
Justyna Nowak ◽  
Janusz Szkodzinski ◽  
Aleksander Danikiewicz ◽  
Ilona Korzonek-Szlacheta ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Body Mass Index ◽  
Coronary Artery ◽  
Weight Status ◽  
Stable Coronary Artery Disease ◽  
Reference Method ◽  
Normal Weight ◽  
Body Adiposity ◽  
Artery Disease

Background and Aims: Body-mass index (BMI) is a popular method implemented to define weight status. However, describing obesity by BMI may result in inaccurate assessment of adiposity. The Body Adiposity Index (BAI) is intended to be a directly validated method of estimating body fat percentage. We set out to compare body weight status assessment by BMI and BAI in a cohort of elderly patients with stable coronary artery disease (CAD). Methods: A total of 169 patients with stable CAD were enrolled in an out-patient cardiology clinic. The National Research Council (US) Committee on Diet and Health classification was used for individuals older than 65 years as underweight BMI < 24 kg/m2, normal weight BMI 24–29 kg/m2, overweight BMI 29–35 kg/m2, and obesity BMI > 35 kg/m2. In case of BAI, we used sex- and age-specific classification of weight status. In addition, body fat was estimated by bioelectrical impedance analysis (BImpA). Results: Only 72 out of 169 patients (42.6%) had concordant classification of weight status by both BMI and BAI. The majority of the patients had their weight status either underestimated or overestimated. There were strong positive correlations between BMI and BImpA (FAT%) (R = 0.78 p < 0.001); BAI and BImpA (FAT%) (R = 0.79 p < 0.001); and BMI and BAI (R = 0.67 p < 0.001). BMI tended to overestimate the rate of underweight, normal weight or overweight, meanwhile underestimating the rate of obesity. Third, BMI exhibited an average positive bias of 14.4% compared to the reference method (BImpA), whereas BAI exhibited an average negative bias of −8.3% compared to the reference method (BImpA). Multivariate logistic regression identified independent predictors of discordance in assessing weight status by BMI and BAI: BImpA (FAT%) odds ratio (OR) 1.29, total body water (%) OR 1.61, fat mass index OR 2.62, and Controlling Nutritional Status (CONUT) score OR 1.25. Conclusions: There is substantial rate of misclassification of weight status between BMI and BAI. These findings have significant implications for clinical practice as the boundary between health and disease in malnutrition is crucial to accurately define criteria for intervention. Perhaps BMI cut-offs for classifying weight status in the elderly should be revisited.

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.

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.

1327 Patient-based vs. nurse-based NYHA classification of patients with chronic heart failure - Influence of mood

2008 ◽  
Vol 7 (1_suppl) ◽  
pp. 17-17
Author(s):  
M. Rydell Karlsson ◽  
Magnus Edner ◽  
Ewa Billing ◽  
Peter Henriksson
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Nyha Classification

scholarly journals Risk Stratification for Atrial Fibrillation and Outcomes in Tachycardia-Bradycardia Syndrome: Ablation vs. Pacing

2021 ◽  
Vol 8 ◽  
Author(s):  
Rongfeng Zhang ◽  
Yue Wang ◽  
Minghui Yang ◽  
Yiheng Yang ◽  
Zhengyan Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Risk Stratification ◽  
Primary Endpoint ◽  
Pacemaker Implantation ◽  
Persistent Atrial Fibrillation ◽  
Nyha Classification

Background: Catheter ablation of atrial fibrillation is an alternative treatment for patients with tachycardia-bradycardia syndrome (TBS) to avoid pacemaker implantation. The risk stratification for atrial fibrillation and outcomes between ablation and pacing has not been fully evaluated.Methods: This retrospective study involved 306 TBS patients, including 141 patients who received catheter ablation (Ablation group, age: 62.2 ± 9.0 months, mean longest pauses: 5.2 ± 2.2 s) and 165 patients who received pacemaker implement (Pacing group, age: 62.3 ± 9.1 months, mean longest pauses: 6.0 ± 2.3 s). The primary endpoint was a composite of call cause mortality, cardiovascular-related hospitalization or thrombosis events (stroke, or peripheral thrombosis). The second endpoint was progress of atrial fibrillation and heart failure.Results: After a median follow-up of 75.4 months, the primary endpoint occurred in significantly higher patients in the pacing group than in the ablation group (59.4 vs.15.6%, OR 6.05, 95% CI: 3.73–9.80, P &lt; 0.001). None of deaths was occurred in ablation group, and 1 death occurred due to cancer. Cardiovascular-related hospitalization occurred in 50.9% of the pacing group compared with 14.2% in the ablation group (OR: 4.87, 95% CI: 2.99–7.95, P &lt; 0.001). More thrombosis events occurred in the pacing group than in the ablation group (12.7 vs. 2.1%, OR 6.06, 95% CI: 1.81–20.35, P = 0.004). Significant more patients progressed to persistent atrial fibrillation in pacing group than in ablation group (23.6 vs. 2.1%, P &lt; 0.001). The NYHA classification of the pacing group was significantly higher than that of the ablation group (2.11 ± 0.83 vs. 1.50 ± 0.74, P &lt; 0.001). The proportion of antiarrhythmic drugs and anticoagulants used in the pacing group was significantly higher than that in the ablation group (41.2 vs. 7.1%, P &lt; 0.001; 16.4 vs. 2.1%, P = 0.009).Conclusion: Catheter ablation for patients with TBS was associated with a significantly lower rate of a composite end point of cardiovascular related hospitalization and thromboembolic events. Furthermore, catheter ablation reduced the progression of atrial fibrillation and heart failure.

scholarly journals Global and National Socioeconomic Disparities in Obesity, Overweight, and Underweight Status

2010 ◽  
Vol 2010 ◽  
pp. 1-11 ◽  
Author(s):  
Spencer Moore ◽  
Justin N. Hall ◽  
Sam Harper ◽  
John W. Lynch
Keyword(s):  
Weight Status ◽  
Normal Weight ◽  
World Health ◽  
Multinomial Regression ◽  
World Health Survey ◽  
Cross Sectional ◽  
National Differences ◽  
International Policies ◽  
Increased Risk

Objective. To examine the association between socioeconomic factors and weight status across 53 countries.Methods. Data are cross-sectional and from the long version of the World Health Survey (WHS). There were 172,625 WHS participants who provided self-reported height and weight measures and sociodemographic information. The International Classification of adult weight status was used to classify participants by body mass index (BMI): (1) underweight (<18.5), (2) normal weight (18.5–24.9), (3) overweight (25.0–29.9), and (4) obese (>30.0). Multinomial regression was used in the analyses.Results. Globally, 6.7% was underweight, 25.7% overweight, and 8.9% obese. Underweight status was least (5.8%) and obesity (9.3%) most prevalent in the richest quintile. There was variability between countries, with a tendency for lower-income quintiles to be at increased risk for underweight and reduced risk for obesity.Conclusion. International policies may require flexibility in addressing cross-national differences in the socio-economic covariates of BMI status.

A PILOT STUDY: PLASMA GALECTIN-3 LEVEL IN HEART FAILURE PATIENTS

2017 ◽  
pp. 101-106
Author(s):  
Thi Thanh Hien Bui ◽  
Hieu Nhan Dinh ◽  
Anh Tien Hoang
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Acute Coronary Syndrome ◽  
Kidney Disease ◽  
Heart Failure Patients ◽  
Coronary Syndrome ◽  
Nyha Classification ◽  
Galectin 3 ◽  
Severe Chronic Kidney Disease ◽  
Esc Guidelines

Background: Despite of considerable advances in its diagnosis and management, heart failure remains an unsettled problem and life threatening. Heart failure with a growing prevalence represents a burden to healthcare system, responsible for deterioration of patient’s daily activities. Galectin-3 is a new cardiac biomarker in prognosis for heart failure. Serum galectin-3 has some relation to heart failure NYHA classification, acute coronary syndrome and clinical outcome. Level of serum galectin-3 give information for prognosis and help risk stratifications in patient with heart failure, so intensive therapeutics can be approached to patients with high risk. Objective: To examine plasma galectin-3 level in hospitalized heart failure patients, investigate the relationship between galectin-3 level with associated diseases, clinical conditions and disease progression in hospital. Methodology: Cross sectional study. Result: 20 patients with severe heart failure as NYHA classification were diagnosed by The ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2012) and performed blood test for serum galectin-3 level. Increasing of serum galectin-3 level have seen in all patients, mean value is 36.5 (13.7 – 74.0), especially high level in patient with acute coronary syndrome and patients with severe chronic kidney disease. There are five patients dead. Conclusion: Serum galectin-3 level increase in patients with heart failure and has some relation to NYHA classification, acute coronary syndrome. However, level of serum galectin-3 can be affected by severe chronic kidney disease, more research is needed on this aspect Key words: Serum galectin-3, heart failure, ESC Guidelines, NYHA

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