In:
European Journal of Heart Failure, Wiley, Vol. 18, No. 7 ( 2016-07), p. 851-858
Abstract:
Paradoxically, obesity is associated with survival in heart failure ( HF ). Whether this is true for HF patients with comorbid type‐2 diabetes ( T2D ) remains uncertain. Our aim was to address this issue in diabetic patients by collecting correlates for body mass index ( BMI ) and long‐term mortality. Method and results Both BMI and survival after a mean follow‐up of 4.3 ± 3.0 years (up to 10 years) were assessed for 2527 ambulatory patients (66.3% men; mean age 69 ± 12.3 years). A total of 1102 (43.6%) patients had T2D and ischaemic aetiology of HF was present in 47.8%; mean left ventricular ejection fraction was 38 ± 16%. Based on BMI scores, patients were categorized as either underweight, normal, overweight, or obese. A significant survival interaction was observed between BMI and T2D . Smooth spline curves for the estimation of risk of all‐cause and cardiovascular death showed the classic obesity paradox, with reduced mortality as BMI increased in non‐diabetics; for T2D patients this pattern was lost. After adjustment for age and sex, hazard ratios for low‐weight and obesity were: 2.04 [95% confidence intervals ( CI ) 1.50–2.78, P 〈 0.001] and 0.76 (95% CI 0.58–0.99, P = 0.04), respectively, for non‐ T2D patients; and 1.30 (95% CI 0.77–2.19, P = 0.32) and 0.99 (95% CI 0.78–1.26, P = 0.95), respectively, for T2D patients. Multivariate analyses for mortality (including BMI as a continuous variable) were significant for non‐diabetic patients only. Conclusions In patients with HF , but without T2D , the obesity paradox was present; however, T2D removed this phenomenon. Advice about weight loss for obese diabetic patients with HF requires further research.
Type of Medium:
Online Resource
ISSN:
1388-9842
,
1879-0844
DOI:
10.1002/ejhf.2016.18.issue-7
Language:
English
Publisher:
Wiley
Publication Date:
2016
detail.hit.zdb_id:
1500332-2
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