Body mass index and survival in people with heart failure
<p><strong>Aims:</strong> In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes (‘obesity paradox’), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023
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| _version_ | 1797111827356712960 |
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| author | Jones, NR Ordonez-Mena, J Roalfe, A Taylor, K Goyder, C Hobbs, F Taylor, C |
| author_facet | Jones, NR Ordonez-Mena, J Roalfe, A Taylor, K Goyder, C Hobbs, F Taylor, C |
| author_sort | Jones, NR |
| collection | OXFORD |
| description | <p><strong>Aims:</strong> In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes (‘obesity paradox’), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort.</p>
<p><strong>Methods:</strong> We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000-2017). We used Kaplan-Meier curves, Cox regression, and penalised splines methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.</p>
<p><strong>Results:</strong> There were 47,531 participants with HF (median age 78.0 years (IQR 70-84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9-31.0)) and 25,013 (52.6%) died during follow-up. Compared to healthy weight, people with overweight (HR 0.78, 95%CI 0.75-0.81, risk difference (RD) -4.1%), obesity class I (HR 0.76, 95%CI 0.73-0.80, RD -4.5%) and class II (HR 0.76, 95%CI 0.71-0.81, RD -4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95%CI 1.45-1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p-value for interaction = 0.02). Class III obesity was associated with increased risk of all-cause mortality compared to overweight (HR 1.23, 95%CI 1.17-1.29).</p>
<p><strong>Conclusion:</strong> The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.</p> |
| first_indexed | 2024-03-07T08:15:54Z |
| format | Journal article |
| id | oxford-uuid:98175598-5ff0-433e-b50a-ae48745b6c71 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:15:54Z |
| publishDate | 2023 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:98175598-5ff0-433e-b50a-ae48745b6c712023-12-20T12:29:45ZBody mass index and survival in people with heart failureJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:98175598-5ff0-433e-b50a-ae48745b6c71EnglishSymplectic ElementsBMJ Publishing Group2023Jones, NROrdonez-Mena, JRoalfe, ATaylor, KGoyder, CHobbs, FTaylor, C<p><strong>Aims:</strong> In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes (‘obesity paradox’), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort.</p> <p><strong>Methods:</strong> We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000-2017). We used Kaplan-Meier curves, Cox regression, and penalised splines methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.</p> <p><strong>Results:</strong> There were 47,531 participants with HF (median age 78.0 years (IQR 70-84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9-31.0)) and 25,013 (52.6%) died during follow-up. Compared to healthy weight, people with overweight (HR 0.78, 95%CI 0.75-0.81, risk difference (RD) -4.1%), obesity class I (HR 0.76, 95%CI 0.73-0.80, RD -4.5%) and class II (HR 0.76, 95%CI 0.71-0.81, RD -4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95%CI 1.45-1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p-value for interaction = 0.02). Class III obesity was associated with increased risk of all-cause mortality compared to overweight (HR 1.23, 95%CI 1.17-1.29).</p> <p><strong>Conclusion:</strong> The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.</p> |
| spellingShingle | Jones, NR Ordonez-Mena, J Roalfe, A Taylor, K Goyder, C Hobbs, F Taylor, C Body mass index and survival in people with heart failure |
| title | Body mass index and survival in people with heart failure |
| title_full | Body mass index and survival in people with heart failure |
| title_fullStr | Body mass index and survival in people with heart failure |
| title_full_unstemmed | Body mass index and survival in people with heart failure |
| title_short | Body mass index and survival in people with heart failure |
| title_sort | body mass index and survival in people with heart failure |
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