Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure

Abhishek Sharma, Carl J. Lavie, Jeffrey S. Borer, Ajay Vallakati, Sunny Goel, Francisco Lopez-Jimenez, Armin Zadeh, Debabrata Mukherjee, Jason M. Lazar

Research output: Contribution to journalArticle

Abstract

Clinical studies have indicated the existence of an "obesity paradox" in patients with chronic heart failure (HF), that is, reduced mortality in patients who have elevated body mass index (BMI) scores compared with normal-weight reference groups. The aim of this study was to investigate the relation of BMI with all-cause and cardiovascular (CV) mortality and hospitalization in patients with chronic HF though a systematic review and meta-analysis of published research. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central, Scopus, web of science and Embase were searched for studies reporting rates of total mortality, cardiac mortality, and risk for hospitalization in patients with HF in various BMI categories (2 [low], 20 to 24.9 kg/m2 [normal reference], 25 to 29.9 kg/m2 [overweight], 30 to 34.9 [obese], and ≥35 kg/m2 [severely obese]). Event rates were compared using a forest plot of relative risk (RR) using a random-effects model assuming interstudy heterogeneity. Two study investigators independently reviewed the 124 reports retrieved and identified 6 for final analyses (n = 22,807). After a mean follow-up period of 2.85 years, the risk for adverse events was highest in patients with low BMIs: total mortality RR 1.27 (95% confidence interval [CI] 1.17 to 1.37), CV mortality RR 1.20 (95% CI 1.01 to 1.43), and hospitalization RR 1.19 (95% CI 1.09 to 1.30). Risk for CV mortality and hospitalization was lowest in overweight patients (RR 0.79, 95% CI 0.70 to 0.90, and RR 0.92, 95% CI 0.86 to 0.97, respectively). Increasing degree of obesity failed to achieve a statistically significant effect on CV mortality (RR 0.82, 95% CI 0.64 to 1.05, and RR 0.71, 95% CI 0.50 to 1.01, for obese and severely obese, respectively) and on hospitalization (RR 0.99, 95% CI 0.92 to 1.07, and RR 1.28, 95% CI 0.88 to 1.87, for obese and severely obese, respectively). In conclusion, risk for total mortality and CV mortality and hospitalization was highest in patients with chronic HF who were underweight as defined by low BMI, whereas risk for CV mortality and hospitalization was lowest in overweight subjects.

Original languageEnglish (US)
Pages (from-to)1428-1434
Number of pages7
JournalThe American Journal of Cardiology
Volume115
Issue number10
DOIs
StatePublished - May 15 2015

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Meta-Analysis
Hospitalization
Body Mass Index
Heart Failure
Mortality
Confidence Intervals
Obesity
Thinness
PubMed
Nursing
Research Personnel

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure. / Sharma, Abhishek; Lavie, Carl J.; Borer, Jeffrey S.; Vallakati, Ajay; Goel, Sunny; Lopez-Jimenez, Francisco; Zadeh, Armin; Mukherjee, Debabrata; Lazar, Jason M.

In: The American Journal of Cardiology, Vol. 115, No. 10, 15.05.2015, p. 1428-1434.

Research output: Contribution to journalArticle

Sharma, Abhishek ; Lavie, Carl J. ; Borer, Jeffrey S. ; Vallakati, Ajay ; Goel, Sunny ; Lopez-Jimenez, Francisco ; Zadeh, Armin ; Mukherjee, Debabrata ; Lazar, Jason M. / Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure. In: The American Journal of Cardiology. 2015 ; Vol. 115, No. 10. pp. 1428-1434.
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abstract = "Clinical studies have indicated the existence of an {"}obesity paradox{"} in patients with chronic heart failure (HF), that is, reduced mortality in patients who have elevated body mass index (BMI) scores compared with normal-weight reference groups. The aim of this study was to investigate the relation of BMI with all-cause and cardiovascular (CV) mortality and hospitalization in patients with chronic HF though a systematic review and meta-analysis of published research. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central, Scopus, web of science and Embase were searched for studies reporting rates of total mortality, cardiac mortality, and risk for hospitalization in patients with HF in various BMI categories (2 [low], 20 to 24.9 kg/m2 [normal reference], 25 to 29.9 kg/m2 [overweight], 30 to 34.9 [obese], and ≥35 kg/m2 [severely obese]). Event rates were compared using a forest plot of relative risk (RR) using a random-effects model assuming interstudy heterogeneity. Two study investigators independently reviewed the 124 reports retrieved and identified 6 for final analyses (n = 22,807). After a mean follow-up period of 2.85 years, the risk for adverse events was highest in patients with low BMIs: total mortality RR 1.27 (95{\%} confidence interval [CI] 1.17 to 1.37), CV mortality RR 1.20 (95{\%} CI 1.01 to 1.43), and hospitalization RR 1.19 (95{\%} CI 1.09 to 1.30). Risk for CV mortality and hospitalization was lowest in overweight patients (RR 0.79, 95{\%} CI 0.70 to 0.90, and RR 0.92, 95{\%} CI 0.86 to 0.97, respectively). Increasing degree of obesity failed to achieve a statistically significant effect on CV mortality (RR 0.82, 95{\%} CI 0.64 to 1.05, and RR 0.71, 95{\%} CI 0.50 to 1.01, for obese and severely obese, respectively) and on hospitalization (RR 0.99, 95{\%} CI 0.92 to 1.07, and RR 1.28, 95{\%} CI 0.88 to 1.87, for obese and severely obese, respectively). In conclusion, risk for total mortality and CV mortality and hospitalization was highest in patients with chronic HF who were underweight as defined by low BMI, whereas risk for CV mortality and hospitalization was lowest in overweight subjects.",
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AU - Lavie, Carl J.

AU - Borer, Jeffrey S.

AU - Vallakati, Ajay

AU - Goel, Sunny

AU - Lopez-Jimenez, Francisco

AU - Zadeh, Armin

AU - Mukherjee, Debabrata

AU - Lazar, Jason M.

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N2 - Clinical studies have indicated the existence of an "obesity paradox" in patients with chronic heart failure (HF), that is, reduced mortality in patients who have elevated body mass index (BMI) scores compared with normal-weight reference groups. The aim of this study was to investigate the relation of BMI with all-cause and cardiovascular (CV) mortality and hospitalization in patients with chronic HF though a systematic review and meta-analysis of published research. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central, Scopus, web of science and Embase were searched for studies reporting rates of total mortality, cardiac mortality, and risk for hospitalization in patients with HF in various BMI categories (2 [low], 20 to 24.9 kg/m2 [normal reference], 25 to 29.9 kg/m2 [overweight], 30 to 34.9 [obese], and ≥35 kg/m2 [severely obese]). Event rates were compared using a forest plot of relative risk (RR) using a random-effects model assuming interstudy heterogeneity. Two study investigators independently reviewed the 124 reports retrieved and identified 6 for final analyses (n = 22,807). After a mean follow-up period of 2.85 years, the risk for adverse events was highest in patients with low BMIs: total mortality RR 1.27 (95% confidence interval [CI] 1.17 to 1.37), CV mortality RR 1.20 (95% CI 1.01 to 1.43), and hospitalization RR 1.19 (95% CI 1.09 to 1.30). Risk for CV mortality and hospitalization was lowest in overweight patients (RR 0.79, 95% CI 0.70 to 0.90, and RR 0.92, 95% CI 0.86 to 0.97, respectively). Increasing degree of obesity failed to achieve a statistically significant effect on CV mortality (RR 0.82, 95% CI 0.64 to 1.05, and RR 0.71, 95% CI 0.50 to 1.01, for obese and severely obese, respectively) and on hospitalization (RR 0.99, 95% CI 0.92 to 1.07, and RR 1.28, 95% CI 0.88 to 1.87, for obese and severely obese, respectively). In conclusion, risk for total mortality and CV mortality and hospitalization was highest in patients with chronic HF who were underweight as defined by low BMI, whereas risk for CV mortality and hospitalization was lowest in overweight subjects.

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