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Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program.

Abstract

BACKGROUND

In individuals without known cardiovascular disease, elevated body mass index (BMI) (weight/height2) is associated with an increased risk of death. However, in patients with certain specific chronic diseases, including heart failure, low BMI has been associated with increased mortality.

METHODS AND RESULTS

We examined the influence of BMI on prognosis using Cox proportional hazards models in 7599 patients (mean age, 65 years; 35% women) with symptomatic heart failure (New York Heart Association class II to IV) and a broad spectrum of left ventricular ejection fractions (mean, 39%) in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. During a median follow-up of 37.7 months, 1831 patients died. After adjustment for potential confounders, compared with patients with BMI between 30 and 34.9, patients in lower BMI categories had a graded increase in the risk of death. The hazard ratios (95% confidence intervals) were 1.22 (1.06 to 1.41), 1.46 (1.24 to 1.71), and 1.69 (1.43 to 2.01) among those with BMI of 25 to 29.9, 22.5 to 24.9, and < 22.5, respectively. The increase in risk of death among patients with BMI > or = 35 was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.95 to 1.43). The association between BMI and mortality was not altered by age, smoking status, or left ventricular ejection fraction (P for interaction >0.20). However, lower BMI was associated with a greater risk of all-cause death in patients without edema but not in patients with edema (P for interaction <0.0001). Lower BMI was associated with a greater risk of cardiovascular death and noncardiovascular death. Baseline BMI did not influence the risk of hospitalization for worsening heart failure or due to all causes.

CONCLUSIONS

In patients with symptomatic heart failure and either reduced or preserved left ventricular systolic function, underweight or low BMI was associated with increased mortality, primarily in patients without evidence of fluid overload (edema).

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. skenchaiah@rics.bwh.harvard.edu

    , , , , , , , , , , , ,

    Source

    Circulation 116:6 2007 Aug 07 pg 627-36

    MeSH

    Aged
    Aged, 80 and over
    Benzimidazoles
    Body Mass Index
    Cohort Studies
    Double-Blind Method
    Female
    Follow-Up Studies
    Heart Failure
    Humans
    Internationality
    Male
    Middle Aged
    Morbidity
    Prognosis
    Survival Rate
    Tetrazoles

    Pub Type(s)

    Comparative Study
    Controlled Clinical Trial
    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17638930

    Citation

    Kenchaiah, Satish, et al. "Body Mass Index and Prognosis in Patients With Chronic Heart Failure: Insights From the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program." Circulation, vol. 116, no. 6, 2007, pp. 627-36.
    Kenchaiah S, Pocock SJ, Wang D, et al. Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Circulation. 2007;116(6):627-36.
    Kenchaiah, S., Pocock, S. J., Wang, D., Finn, P. V., Zornoff, L. A., Skali, H., ... Solomon, S. D. (2007). Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Circulation, 116(6), pp. 627-36.
    Kenchaiah S, et al. Body Mass Index and Prognosis in Patients With Chronic Heart Failure: Insights From the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Circulation. 2007 Aug 7;116(6):627-36. PubMed PMID: 17638930.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. AU - Kenchaiah,Satish, AU - Pocock,Stuart J, AU - Wang,Duolao, AU - Finn,Peter V, AU - Zornoff,Leonardo A M, AU - Skali,Hicham, AU - Pfeffer,Marc A, AU - Yusuf,Salim, AU - Swedberg,Karl, AU - Michelson,Eric L, AU - Granger,Christopher B, AU - McMurray,John J V, AU - Solomon,Scott D, AU - ,, Y1 - 2007/07/16/ PY - 2007/7/20/pubmed PY - 2007/8/29/medline PY - 2007/7/20/entrez SP - 627 EP - 36 JF - Circulation JO - Circulation VL - 116 IS - 6 N2 - BACKGROUND: In individuals without known cardiovascular disease, elevated body mass index (BMI) (weight/height2) is associated with an increased risk of death. However, in patients with certain specific chronic diseases, including heart failure, low BMI has been associated with increased mortality. METHODS AND RESULTS: We examined the influence of BMI on prognosis using Cox proportional hazards models in 7599 patients (mean age, 65 years; 35% women) with symptomatic heart failure (New York Heart Association class II to IV) and a broad spectrum of left ventricular ejection fractions (mean, 39%) in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. During a median follow-up of 37.7 months, 1831 patients died. After adjustment for potential confounders, compared with patients with BMI between 30 and 34.9, patients in lower BMI categories had a graded increase in the risk of death. The hazard ratios (95% confidence intervals) were 1.22 (1.06 to 1.41), 1.46 (1.24 to 1.71), and 1.69 (1.43 to 2.01) among those with BMI of 25 to 29.9, 22.5 to 24.9, and < 22.5, respectively. The increase in risk of death among patients with BMI > or = 35 was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.95 to 1.43). The association between BMI and mortality was not altered by age, smoking status, or left ventricular ejection fraction (P for interaction >0.20). However, lower BMI was associated with a greater risk of all-cause death in patients without edema but not in patients with edema (P for interaction <0.0001). Lower BMI was associated with a greater risk of cardiovascular death and noncardiovascular death. Baseline BMI did not influence the risk of hospitalization for worsening heart failure or due to all causes. CONCLUSIONS: In patients with symptomatic heart failure and either reduced or preserved left ventricular systolic function, underweight or low BMI was associated with increased mortality, primarily in patients without evidence of fluid overload (edema). SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/17638930/full_citation L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.106.679779?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -