Weight Change and Mortality Risk in Heart Failure With Preserved Ejection Fraction

Associations of short-term changes in obesity indices with all-cause mortality and cardiovascular disease

OBJECTIVE

This study aimed to investigate how short-term changes (1-, 3-, and 5-year) in obesity measures affect mortality and cardiovascular disease (CVD) risk.

METHODS

We analyzed longitudinal data from the MJ Health Centre (n = 43,304 for the 1-year study; 24,295 for the 3-year study; 16,138 for the 5-year study) with median follow-up periods of 15.8, 13.9, and 12.3 years, respectively. Associations of short-term obesity indices changes with mortality and Framingham Risk Score changes were explored using time-dependent coefficient Cox regression models, restricted cubic splines, and multivariable linear regression models.

RESULTS

All-cause mortality was negatively associated with short-term weight and BMI changes, with greater reductions causing poorer outcomes. Compared with stable groups, short-term reduced weight and BMI were associated with greater risks of all-cause mortality and CVD-specific mortality (5-year study only). Also, either 1- and 3-year reduced or 3-year increased waist circumference and waist to height ratio were related to higher all-cause and CVD deaths than stable groups, respectively. Nonlinear relationships indicated lower cutoff values for short-term changes in obesity indices in predicting all-cause mortality. Decreased obesity indices significantly improved CVD profiles.

CONCLUSIONS

Short-term changes in obesity indices show complex mortality risks, urging personalized approaches beyond a simple weight loss focus.

Association of weight loss with cardiovascular or all-cause mortality in patients with heart failure: A meta-analysis

BACKGROUND

A consensus has not been reached on the association between weight loss and survival outcomes in patients with heart failure (HF). This meta-analysis aimed to assess the association of weight loss with cardiovascular or all-cause mortality in patients with HF.

METHODS

Two authors independently searched the articles indexed in the PubMed and Embase databases up to May 7, 2023. Post hoc analysis of randomized controlled trials or observational studies that reported the utility of weight loss in predicting cardiovascular or all-cause mortality in patients with HF were included.

RESULTS

Thirteen studies reporting on 12 articles involving 26,164 patients with HF were included. A comparison of weight loss with stable weight showed that the pooled adjusted hazard ratio (HR) for all-cause mortality was 1.75 (95% confidence intervals [CI] 1.43-2.14). Subgroup analysis revealed that weight loss was associated with an increased risk of all-cause mortality, irrespective of whether patients were overweight/obese (HR 1.76; 95% CI 1.41-2.20) or not (HR 1.90; 95% CI 1.14-3.14). The pooled adjusted HR of cardiovascular mortality was 1.64 (95% CI 1.18-2.28) for patients with weight loss compared to those without.

CONCLUSIONS

Weight loss is associated with an increased risk of cardiovascular and all-cause mortality in patients with HF. Assessing weight changes can provide prognostic information for patients with HF.

Effects of weight loss in heart failure patients with overweight and obesity: a systematic review and meta-analysis

AIMS

To perform a systematic review and meta-analysis to evaluate the impact of weight loss (WL) on the prognosis of overweight and obese patients with heart failure (HF).

METHODS AND RESULTS

We reviewed the literature up to 1 February 2023 from PubMed, Web of Science, Embase, Cochrane Library, and Chinese databases for cohort studies, and randomized controlled trials (RCTs). Data from eligible studies were extracted, and statistical analyses were performed using Review Manager 5.3. A total of 19 studies (involving 449 882 patients) were included in the systematic review and meta-analyses. The results showed that WL did not reduce the mortality and rehospitalization rates in overweight and obese HF patients, but could improve the quality of life (P = 0.002), cardiac function (P = 0.0001), and exercise capacity (P = 0.03). The subgroup analysis showed that WL from bariatric surgery (BS) reduced the risk of death (P < 0.00001), WL from medication or exercise was not significantly associated with the risk of death (P = 0.18), and WL was associated with a higher mortality in the subgroup with unspecified WL modality or unintentional WL (P < 0.00001). In addition, it did not reduce the risk of short-term rehospitalization (P = 0.11), but reduced the rehospitalization rates over the long-term (P = 0.03).

CONCLUSION

WL improves the long-term rehospitalization (>3 months), quality of life, cardiac function, and exercise capacity in overweight and obese HF patients. Although overall WL is not proven effective, subgroup analysis shows that BS can reduce mortality.

Obesity in heart failure with preserved ejection fraction with and without diabetes: risk factor or innocent bystander?

AIMS

Heart failure with preserved ejection fraction (HFpEF) is a condition that commonly coexists with type 2 diabetes mellitus (T2DM) and obesity. Whether the obesity-related survival benefit generally observed in HFpEF extends to individuals with concomitant T2DM is unclear. This study sought to examine the prognostic role of overweight and obesity in a large cohort of HFpEF with and without T2DM.

METHODS AND RESULTS

This large-scale cohort study included patients with HFpEF enrolled between 2010 and 2020. The relationship between body mass index (BMI), T2DM, and survival was assessed. A total of 6744 individuals with HFpEF were included, of which 1702 (25%) had T2DM. Patients with T2DM had higher BMI values (29.4 kg/m2 vs. 27.1 kg/m2, P < 0.001), higher N-terminal pro-brain natriuretic peptide values (864 mg/dL vs. 724 mg/dL, P < 0.001), and a higher prevalence of numerous risk factors/comorbidities than those without T2DM. During a median follow-up time of 47 months (Q1-Q3: 20-80), 2014 (30%) patients died. Patients with T2DM had a higher incidence of fatal events compared with those without T2DM, with a mortality rate of 39.2% and 26.7%, respectively (P < 0.001). In the overall cohort, using the BMI category 22.5-24.9 kg/m2 as the reference group, the unadjusted hazard ratio (HR) for all-cause death was increased in patients with BMI <22.5 kg/m2 [HR: 1.27 (confidence interval 1.09-1.48), P = 0.003] and decreased in BMI categories ≥25 kg/m2. After multivariate adjustment, BMI remained significantly inversely associated with survival in non-T2DM, whereas survival was unaltered at a wide range of BMI in patients with T2DM.

CONCLUSION

Among the various phenotypes of HFpEF, the T2DM phenotype is specifically associated with a greater disease burden. Higher BMI is linked to improved survival in HFpEF overall, while this effect neutralises in patients with concomitant T2DM. Advising BMI-based weight targets and weight loss may be pursued with different intensity in the management of HFpEF, particularly in the presence of T2DM.

Risk Prediction Models and Novel Prognostic Factors for Heart Failure with Preserved Ejection Fraction: A Systematic and Comprehensive Review

BACKGROUND

Patients with heart failure with preserved ejection fraction (HFpEF) have large individual differences, unclear risk stratification, and imperfect treatment plans. Risk prediction models are helpful for the dynamic assessment of patients' prognostic risk and early intensive therapy of high-risk patients. The purpose of this study is to systematically summarize the existing risk prediction models and novel prognostic factors for HFpEF, to provide a reference for the construction of convenient and efficient HFpEF risk prediction models.

METHODS

Studies on risk prediction models and prognostic factors for HFpEF were systematically searched in relevant databases including PubMed and Embase. The retrieval time was from inception to February 1, 2023. The Quality in Prognosis Studies (QUIPS) tool was used to assess the risk of bias in included studies. The predictive value of risk prediction models for end outcomes was evaluated by sensitivity, specificity, the area under the curve, C-statistic, C-index, etc. In the literature screening process, potential novel prognostic factors with high value were explored.

RESULTS

A total of 21 eligible HFpEF risk prediction models and 22 relevant studies were included. Except for 2 studies with a high risk of bias and 2 studies with a moderate risk of bias, other studies that proposed risk prediction models had a low risk of bias overall. Potential novel prognostic factors for HFpEF were classified and described in terms of demographic characteristics (age, sex, and race), lifestyle (physical activity, body mass index, weight change, and smoking history), laboratory tests (biomarkers), physical inspection (blood pressure, electrocardiogram, imaging examination), and comorbidities.

CONCLUSION

It is of great significance to explore the potential novel prognostic factors of HFpEF and build a more convenient and efficient risk prediction model for improving the overall prognosis of patients. This review can provide a substantial reference for further research.

Association Between Obesity and Lower Short- and Long-Term Mortality in Coronary Care Unit Patients: A Cohort Study of the MIMIC-III Database

INTRODUCTION

Obesity has long been considered an independent risk factor for cardiovascular diseases (CVD), even in the COVID-19 pandemic. However, recent studies have found that a certain degree of obesity may be beneficial for patients who have already suffered from CVD, which is called the "obesity paradox". Our objective was to investigate whether the obesity paradox existed in coronary care unit (CCU) patients and the relationship between body mass index (BMI) and short- and long-term mortality.

METHODS

We performed a cohort analysis of 3,502 adult CCU patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The patients were divided into four groups according to the WHO BMI categories. Both multivariable logistic regression and Cox regression were used to reveal the relation between BMI and mortality. Subgroup analyses were performed based on Simplified Acute Physiology Score (SAPS) and age.

RESULTS

After adjusting for confounders, obese patients had 33% and 30% lower mortality risk at 30-day and 1-year (OR 0.67, 95% CI 0.51 to 0.89; HR 0.70, 95% CI 0.59 to 0.83; respectively) compared with normal-weight patients, while the underweight group were opposite, with 141% and 81% higher in short- and long-term (OR 2.41, 95% CI 1.37 to 4.12; HR 1.81, 95% CI 1.34 to 2.46; respectively). Overweight patients did not have a significant survival advantage at 30-day (OR 0.91, 95% CI 0.70 to 1.17), but did have a 22% lower mortality risk at 1-year (HR 0.78; 95% CI 0.67 to 0.91). The results were consistent after being stratified by SAPS and age.

CONCLUSION

Our study supports that obesity improved survival at both 30-day and 1-year after CCU admission, and the obesity paradox existed in CCU patients.