Pre-morbid body mass index and mortality after incident heart failure

The ARIC study

Umair Khalid, Sameer Ather, Chirag Bavishi, Wenyaw Chan, Laura R. Loehr, Lisa M. Wruck, Wayne D. Rosamond, Patricia P. Chang, Josef Coresh, Salim S. Virani, Vijay Nambi, Biykem Bozkurt, Christie M. Ballantyne, Anita Deswal

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Although obesity is an independent risk factor for heart failure (HF), once HF is established, obesity is associated with lower mortality. It is unclear if the weight loss due to advanced HF leads to this paradoxical finding.

OBJECTIVES: This study sought to evaluate the prognostic impact of pre-morbid obesity in patients with HF.

METHODS: In the ARIC (Atherosclerosis Risk In Communities) study, we used body mass index (BMI) measured ≥6 months before incident HF (pre-morbid BMI) to evaluate the association of overweight (BMI 25 to 2) and obesity (BMI ≥30 kg/m2) compared with normal BMI (18.5 to 2) with mortality after incident HF.

RESULTS: Among 1,487 patients with incident HF, 35% were overweight and 47% were obese by pre-morbid BMI measured 4.3 ± 3.1 years before HF diagnosis. Over 10-year follow-up after incident HF, 43% of patients died. After adjustment for demographics and comorbidities, being pre-morbidly overweight (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.58 to 0.90; p = 0.004) or obese (HR: 0.70; 95% CI: 0.56 to 0.87; p = 0.001) had a protective association with survival compared with normal BMI. The protective effect of overweight and obesity was consistent across subgroups on the basis of a history of cancer, smoking, and diabetes.

CONCLUSIONS: Our results, for the first time, demonstrate that patients who were overweight or obese before HF development have lower mortality after HF diagnosis compared with normal BMI patients. Thus, weight loss due to advanced HF may not completely explain the protective effect of higher BMI in HF patients.

Original languageEnglish (US)
Pages (from-to)2743-2749
Number of pages7
JournalJournal of the American College of Cardiology
Volume64
Issue number25
DOIs
StatePublished - Dec 30 2014

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Atherosclerosis
Body Mass Index
Heart Failure
Mortality
Obesity
Weight Loss
Confidence Intervals
Morbid Obesity
Comorbidity
Smoking
Demography
Survival

Keywords

  • obesity paradox
  • outcomes
  • overweight
  • pre-morbid

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Khalid, U., Ather, S., Bavishi, C., Chan, W., Loehr, L. R., Wruck, L. M., ... Deswal, A. (2014). Pre-morbid body mass index and mortality after incident heart failure: The ARIC study. Journal of the American College of Cardiology, 64(25), 2743-2749. https://doi.org/10.1016/j.jacc.2014.09.067

Pre-morbid body mass index and mortality after incident heart failure : The ARIC study. / Khalid, Umair; Ather, Sameer; Bavishi, Chirag; Chan, Wenyaw; Loehr, Laura R.; Wruck, Lisa M.; Rosamond, Wayne D.; Chang, Patricia P.; Coresh, Josef; Virani, Salim S.; Nambi, Vijay; Bozkurt, Biykem; Ballantyne, Christie M.; Deswal, Anita.

In: Journal of the American College of Cardiology, Vol. 64, No. 25, 30.12.2014, p. 2743-2749.

Research output: Contribution to journalArticle

Khalid, U, Ather, S, Bavishi, C, Chan, W, Loehr, LR, Wruck, LM, Rosamond, WD, Chang, PP, Coresh, J, Virani, SS, Nambi, V, Bozkurt, B, Ballantyne, CM & Deswal, A 2014, 'Pre-morbid body mass index and mortality after incident heart failure: The ARIC study', Journal of the American College of Cardiology, vol. 64, no. 25, pp. 2743-2749. https://doi.org/10.1016/j.jacc.2014.09.067
Khalid, Umair ; Ather, Sameer ; Bavishi, Chirag ; Chan, Wenyaw ; Loehr, Laura R. ; Wruck, Lisa M. ; Rosamond, Wayne D. ; Chang, Patricia P. ; Coresh, Josef ; Virani, Salim S. ; Nambi, Vijay ; Bozkurt, Biykem ; Ballantyne, Christie M. ; Deswal, Anita. / Pre-morbid body mass index and mortality after incident heart failure : The ARIC study. In: Journal of the American College of Cardiology. 2014 ; Vol. 64, No. 25. pp. 2743-2749.
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abstract = "BACKGROUND: Although obesity is an independent risk factor for heart failure (HF), once HF is established, obesity is associated with lower mortality. It is unclear if the weight loss due to advanced HF leads to this paradoxical finding.OBJECTIVES: This study sought to evaluate the prognostic impact of pre-morbid obesity in patients with HF.METHODS: In the ARIC (Atherosclerosis Risk In Communities) study, we used body mass index (BMI) measured ≥6 months before incident HF (pre-morbid BMI) to evaluate the association of overweight (BMI 25 to 2) and obesity (BMI ≥30 kg/m2) compared with normal BMI (18.5 to 2) with mortality after incident HF.RESULTS: Among 1,487 patients with incident HF, 35{\%} were overweight and 47{\%} were obese by pre-morbid BMI measured 4.3 ± 3.1 years before HF diagnosis. Over 10-year follow-up after incident HF, 43{\%} of patients died. After adjustment for demographics and comorbidities, being pre-morbidly overweight (hazard ratio [HR]: 0.72; 95{\%} confidence interval [CI]: 0.58 to 0.90; p = 0.004) or obese (HR: 0.70; 95{\%} CI: 0.56 to 0.87; p = 0.001) had a protective association with survival compared with normal BMI. The protective effect of overweight and obesity was consistent across subgroups on the basis of a history of cancer, smoking, and diabetes.CONCLUSIONS: Our results, for the first time, demonstrate that patients who were overweight or obese before HF development have lower mortality after HF diagnosis compared with normal BMI patients. Thus, weight loss due to advanced HF may not completely explain the protective effect of higher BMI in HF patients.",
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AU - Ather, Sameer

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AU - Chan, Wenyaw

AU - Loehr, Laura R.

AU - Wruck, Lisa M.

AU - Rosamond, Wayne D.

AU - Chang, Patricia P.

AU - Coresh, Josef

AU - Virani, Salim S.

AU - Nambi, Vijay

AU - Bozkurt, Biykem

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