Document Detail


Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus: a propensity-matched study.
MedLine Citation:
PMID:  20930001     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Obesity is paradoxically associated with survival benefit in patients with chronic heart failure (HF). However, obesity complicates the management of diabetes mellitus (DM), which is common in HF. Yet, little is known about the impact of obesity in HF patients with DM. Therefore, we examined the association between obesity and outcomes in propensity-matched cohorts of HF patient with and without DM.
METHODS AND RESULTS: Of the 7788 participants with chronic mild to moderate HF in the Digitalis Investigation Group trial, 7379 were non-cachectic [body mass index (BMI) ≥ 20 kg/m²] at baseline. Of these, 2153 (29%) had DM, of whom 798 (37%) were obese (BMI ≥ 30 kg/m²). Of the 5226 patients without DM, 1162 (22%) were obese. Propensity scores for obesity were used to separately assemble 636 pairs of obese and non-obese patients with DM and 770 pairs of obese and non-obese patients without DM, who were balanced on 32 baseline characteristics. Among matched patients with DM, all-cause mortality occurred in 38 and 39% of obese and non-obese patients, respectively [hazard ratio (HR) when obesity was compared with no obesity 0.99; 95% confidence interval (CI) 0.80-1.22; P = 0.915]. Among matched patients without DM, all-cause mortality occurred in 23 and 27% obese and non-obese patients, respectively (HR associated with obesity 0.77; 95% CI 0.61-0.97; P = 0.025).
CONCLUSION: In patients with chronic mild to moderate HF and DM, obesity confers no paradoxical survival benefit. Whether intentional weight loss may improve outcomes in these patients needs to be investigated in future prospective studies.
Authors:
Chris Adamopoulos; Philippe Meyer; Ravi V Desai; Kyparissi Karatzidou; Fernando Ovalle; Michel White; Inmaculada Aban; Thomas E Love; Prakash Deedwania; Stefan D Anker; Ali Ahmed
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2010-10-07
Journal Detail:
Title:  European journal of heart failure     Volume:  13     ISSN:  1879-0844     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-25     Completed Date:  2011-05-09     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  200-6     Citation Subset:  IM    
Affiliation:
Papageorgiou General Hospital, Thessaloniki, Greece.
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MeSH Terms
Descriptor/Qualifier:
Aged
Body Mass Index*
Case-Control Studies
Cause of Death*
Chronic Disease
Confidence Intervals
Diabetes Mellitus / diagnosis,  drug therapy,  mortality*
Female
Follow-Up Studies
Heart Failure / diagnosis,  mortality*,  therapy
Humans
Male
Middle Aged
Obesity / diagnosis,  mortality*
Proportional Hazards Models
Risk Assessment
Severity of Illness Index
Survival Analysis
Grant Support
ID/Acronym/Agency:
R01-HL085561/HL/NHLBI NIH HHS; R01-HL097047/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Eur J Heart Fail. 2011 Feb;13(2):130-2   [PMID:  21262928 ]

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