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Anthropometric measures and long‐term mortality in non‐ischaemic heart failure with reduced ejection fraction: Questioning the obesity paradox
European Journal of Heart Failure ( IF 16.9 ) Pub Date : 2024-08-19 , DOI: 10.1002/ejhf.3424 Jawad H Butt 1, 2, 3 , Jens Jakob Thune 4, 5 , Jens C Nielsen 6, 7 , Jens Haarbo 8 , Lars Videbæk 9 , Finn Gustafsson 1, 4 , Søren L Kristensen 1 , Niels E Bruun 3, 4, 10 , Hans Eiskjær 6 , Axel Brandes 11, 12 , Christian Hassager 1, 4 , Jesper H Svendsen 1, 4 , Dan E Høfsten 1, 4 , Christian Torp-Pedersen 13, 14 , Morten Schou 8 , Steen Pehrson 1 , Milton Packer 15 , John J V McMurray 2 , Lars Køber 1, 4
European Journal of Heart Failure ( IF 16.9 ) Pub Date : 2024-08-19 , DOI: 10.1002/ejhf.3424 Jawad H Butt 1, 2, 3 , Jens Jakob Thune 4, 5 , Jens C Nielsen 6, 7 , Jens Haarbo 8 , Lars Videbæk 9 , Finn Gustafsson 1, 4 , Søren L Kristensen 1 , Niels E Bruun 3, 4, 10 , Hans Eiskjær 6 , Axel Brandes 11, 12 , Christian Hassager 1, 4 , Jesper H Svendsen 1, 4 , Dan E Høfsten 1, 4 , Christian Torp-Pedersen 13, 14 , Morten Schou 8 , Steen Pehrson 1 , Milton Packer 15 , John J V McMurray 2 , Lars Køber 1, 4
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AimsAlthough body mass index (BMI) is the most commonly used anthropometric measure to assess adiposity, alternative indices such as the waist‐to‐height ratio may better reflect the location and amount of ectopic fat as well as the weight of the skeleton.Methods and resultsThe prognostic value of several alternative anthropometric measures was compared with that of BMI in 1116 patients with non‐ischaemic heart failure with reduced ejection fraction (HFrEF) enrolled in DANISH. The association between anthropometric measures and all‐cause death was adjusted for prognostic variables, including natriuretic peptides. Median follow‐up was 9.5 years (25th–75th percentile, 7.9–10.9). Compared to patients with a BMI 18.5–24.9 kg/m2 (n = 363), those with a BMI ≥25 kg/m2 had a higher risk of all‐cause and cardiovascular death, although this association was only statistically significant for a BMI ≥35 kg/m2 (n = 91) (all‐cause death: hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.28–2.48; cardiovascular death: HR 2.46, 95% CI 1.69–3.58). Compared to a BMI 18.5–24.9 kg/m2 , a BMI <18.5 kg/m2 (n = 24) was associated with a numerically, but not a significantly, higher risk of all‐cause and cardiovascular death. Greater waist‐to‐height ratio (as an exemplar of indices not incorporating weight) was also associated with a higher risk of all‐cause and cardiovascular death (HR for the highest vs. the lowest quintile: all‐cause death: HR 2.11, 95% CI 1.53–2.92; cardiovascular death: HR 2.17, 95% CI 1.49–3.15).ConclusionIn patients with non‐ischaemic HFrEF, there was a clear association between greater adiposity and higher long‐term mortality.Clinical Trial Registration: ClinicalTrials.gov NCT00542945.
中文翻译：
射血分数降低的非缺血性心力衰竭的人体测量指标和长期死亡率：质疑肥胖悖论
目的虽然体重指数 (BMI) 是评估肥胖最常用的人体测量指标，但腰围与身高之比等替代指标可能更好地反映异位脂肪的位置和数量以及骨骼的重量。结果在丹麦纳入的 1116 名射血分数降低的非缺血性心力衰竭 (HFrEF) 患者中，将几种替代人体测量指标的预后价值与 BMI 进行了比较。人体测量指标与全因死亡之间的关联根据预后变量（包括利尿钠肽）进行了调整。中位随访时间为 9.5 年（第 25-75 个百分位数，7.9-10.9）。与 BMI 18.5–24.9 kg/m2 的患者相比2 （ n = 363), BMI ≥ 25 kg/m 的人2全因死亡和心血管死亡的风险较高，尽管这种关联仅在 BMI ≥ 35 kg/m 时才具有统计学意义2 （ n = 91）（全因死亡：风险比 [HR] 1.78，95% 置信区间 [CI] 1.28–2.48；心血管死亡：HR 2.46，95% CI 1.69–3.58）。与 BMI 18.5–24.9 kg/m 相比2 , BMI <18 id=27>2 （ n = 24）与全因死亡和心血管死亡的风险在数字上相关，但并不显着。较大的腰围与身高之比（作为不包含体重的指数的一个例子）也与较高的全因死亡和心血管死亡风险相关（最高与最低五分位的HR：全因死亡：HR 2.11， 95% CI 1.53–2.92；心血管死亡：HR 2.17，95% CI 1.49–3.15)。结论在非缺血性 HFrEF 患者中，肥胖程度较高与长期死亡率较高之间存在明显关联。临床试验注册：ClinicalTrials.gov NCT00542945。
更新日期：2024-08-19
中文翻译：
射血分数降低的非缺血性心力衰竭的人体测量指标和长期死亡率：质疑肥胖悖论
目的虽然体重指数 (BMI) 是评估肥胖最常用的人体测量指标，但腰围与身高之比等替代指标可能更好地反映异位脂肪的位置和数量以及骨骼的重量。结果在丹麦纳入的 1116 名射血分数降低的非缺血性心力衰竭 (HFrEF) 患者中，将几种替代人体测量指标的预后价值与 BMI 进行了比较。人体测量指标与全因死亡之间的关联根据预后变量（包括利尿钠肽）进行了调整。中位随访时间为 9.5 年（第 25-75 个百分位数，7.9-10.9）。与 BMI 18.5–24.9 kg/m2 的患者相比2 （ n = 363), BMI ≥ 25 kg/m 的人2全因死亡和心血管死亡的风险较高，尽管这种关联仅在 BMI ≥ 35 kg/m 时才具有统计学意义2 （ n = 91）（全因死亡：风险比 [HR] 1.78，95% 置信区间 [CI] 1.28–2.48；心血管死亡：HR 2.46，95% CI 1.69–3.58）。与 BMI 18.5–24.9 kg/m 相比2 , BMI <18 id=27>2 （ n = 24）与全因死亡和心血管死亡的风险在数字上相关，但并不显着。较大的腰围与身高之比（作为不包含体重的指数的一个例子）也与较高的全因死亡和心血管死亡风险相关（最高与最低五分位的HR：全因死亡：HR 2.11， 95% CI 1.53–2.92；心血管死亡：HR 2.17，95% CI 1.49–3.15)。结论在非缺血性 HFrEF 患者中，肥胖程度较高与长期死亡率较高之间存在明显关联。临床试验注册：ClinicalTrials.gov NCT00542945。
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