No benefit from the obesity paradox for diabetic patients with heart failure

Aims Paradoxically, obesity is associated with survival in heart failure (HF). Whether this is true for HF patients with comorbid type‐2 diabetes (T2D) remains uncertain. Our aim was to address this issue in diabetic patients by collecting correlates for body mass index (BMI) and long‐term mortality...

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Published in:European journal of heart failure 2016-07, Vol.18 (7), p.851-858
Main Authors: Zamora, Elisabet, Lupón, Josep, Enjuanes, Cristina, Pascual-Figal, Domingo, de Antonio, Marta, Domingo, Mar, Comín-Colet, Josep, Vila, Joan, Peñafiel, Judith, Farré, Núria, Alonso, Núria, Santesmases, Javier, Troya, Maribel, Bayés-Genís, Antoni
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Body Mass Index
Cardiovascular Diseases - mortality
Cause of Death
Comorbidity
Diabetes
Diabetes Mellitus, Type 2 - epidemiology
Female
Follow-Up Studies
Heart failure
Heart Failure - epidemiology
Heart Failure - mortality
Heart Failure - physiopathology
Humans
Male
Middle Aged
Mortality
Multivariate Analysis
Obesity - epidemiology
Overweight - epidemiology
Proportional Hazards Models
Protective Factors
Risk Factors
Stroke Volume
Survival Rate
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Summary:Aims Paradoxically, obesity is associated with survival in heart failure (HF). Whether this is true for HF patients with comorbid type‐2 diabetes (T2D) remains uncertain. Our aim was to address this issue in diabetic patients by collecting correlates for body mass index (BMI) and long‐term mortality. Method and results Both BMI and survival after a mean follow‐up of 4.3 ± 3.0 years (up to 10 years) were assessed for 2527 ambulatory patients (66.3% men; mean age 69 ± 12.3 years). A total of 1102 (43.6%) patients had T2D and ischaemic aetiology of HF was present in 47.8%; mean left ventricular ejection fraction was 38 ± 16%. Based on BMI scores, patients were categorized as either underweight, normal, overweight, or obese. A significant survival interaction was observed between BMI and T2D. Smooth spline curves for the estimation of risk of all‐cause and cardiovascular death showed the classic obesity paradox, with reduced mortality as BMI increased in non‐diabetics; for T2D patients this pattern was lost. After adjustment for age and sex, hazard ratios for low‐weight and obesity were: 2.04 [95% confidence intervals (CI) 1.50–2.78, P 
ISSN:1388-9842
1879-0844
DOI:10.1002/ejhf.576