Anthropometric Measures and Long-Term Mortality in Non-Ischaemic Heart Failure with Reduced Ejection Fraction: Questioning the Obesity Paradox
Jawad H. Butt, Jens Jakob Thune, Jens Cosedis Nielsen, Jens Haarbo, Lars Videbæk, Finn Gustafsson, Søren Lund Kristensen, Niels Eske Bruun, Hans Eiskjær, Axel Brandes, Christian Hassager, Jesper Hastrup Svendsen, Dan Eik Høfsten, Christian Torp‐Pedersen, Morten Schou, Steen Pehrson, Milton Packer, John J.V. McMurray, Lars Køber
Abstract
Abstract Aims Although 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 results The 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). Conclusion In patients with non-ischaemic HFrEF, there was a clear association between greater adiposity and higher long-term mortality. Clinical Trial Registration: ClinicalTrials.gov NCT00542945.