posted on 2018-07-25, 14:04authored byKoen W. Streng, Adriaan A. Voors, Hans L. Hillege, Stefan D. Anker, John G. Cleland, Kenneth Dickstein, Gerasimos Filippatos, Marco Metra, Leong L. Ng, Piotr Ponikowski, Nilesh J. Samani, Dirk J. Van Veldhuisen, Aeilko H. Zwinderman, Faiez Zannad, Kevin Damman, Peter Van der Meer, Chim C. Lang
Aims: A higher body mass index (BMI) is associated with better survival in heart failure (HF)
patients, also known as the obesity paradox. However, BMI does not account for body composition.
We therefore analysed the association between abdominal fat, measured via waist-hip ratio (WHR),
BMI and all-cause mortality in patients with HF.
Methods: For this analysis 1738 patients from The Scottish BIOlogy Study to TAilored Treatment in
Chronic Heart Failure (BIOSTAT-CHF) validation study were included. Patients without waist and
hip measurements were excluded. WHR was defined as waist circumference/hip circumference,
divided into tertiles and split for sex. A linear regression of principal components from an extensive
panel of biomarkers was performed to provide insight in the pathophysiology behind a higher WHR.
Results: In total, 1479 patients with were included, of which 33% were female and mean age was
75±11 years. A higher WHR was independently associated with a higher BMI, a higher prevalence of
diabetes and higher functional NYHA class. There was a significant interaction between sex and WHR
on its association with mortality (P<0.001). In women, a higher WHR was associated with a higher
mortality risk (HR 2.01; 95% confidence interval (CI) 1.33-3.02, P=0.001), whereas no significant
association was found in men (HR 1.21, 95% CI 0.87-1.69, P=0.262). We found a strong association
between a higher WHR and elevated markers of inflammation and MAPK cascade in women, while in
men these associations were less profound.
Conclusions: A higher WHR was associated with a higher risk of death in female, but not in male HF
patients. These findings challenge the obesity paradox, and suggest that fat deposition is
pathophysiologically harmful and may be a target for therapy in female patients with HF.
Funding
This work was supported by the Netherlands Cardiovascular Research Initiative: an initiative with
support of the Dutch Heart Foundation [CVON2014-11 RECONNECT] and a grant from the
European Commission [FP7-242209-BIOSTAT-CHF; EudraCT 2010–020808–29].
History
Citation
European Journal of Heart Failure, 2018, 20(9), pp. 1269-1277
Author affiliation
/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences
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