Massimo F Piepoli1, Ugo Corrà2, Fabrizio Veglia3, Alice Bonomi3, Elisabetta Salvioni3, Gaia Cattadori3,4, Marco Metra5, Carlo Lombardi5, Gianfranco Sinagra6, Giuseppe Limongelli7, Rosa Raimondo8, Federica Re9, Damiano Magrì10, Romualdo Belardinelli11, Gianfranco Parati12, Chiara Minà13, Angela B Scardovi14, Marco Guazzi15, Mariantonietta Cicoira16, Domenico Scrutinio17, Andrea Di Lenarda18, Maurizio Bussotti19, Maria Frigerio20, Michele Correale21, Giovanni Quinto Villani1, Stefania Paolillo22, Claudio Passino3,23,24, Piergiuseppe Agostoni3,25. 1. Heart Failure Unit, Cardiology Department, G da Saliceto Hospital, Piacenza, Italy. 2. Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy. 3. Centro Cardiologico Monzino, IRCCS, Milano, Italy. 4. Unità Operativa Cardiologia Riabilitativa, Ospedale S.Giuseppe, Multimedica Spa, IRCCS, Milano, Italy. 5. Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy. 6. Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy. 7. Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy. 8. Salvatore Maugeri Foundation, IRCCS, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, Tradate, Italy. 9. Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, St.Camillo-Forlanini Hospital, Roma, Italy. 10. Department of Clinical and Molecular Medicine, La Sapienza University, Roma, Italy. 11. Cardiologia Riabilitativa, Azienda Ospedali Riuniti, Ancona, Italy. 12. Department of Health Science, University of Milano Bicocca and Department of Cardiology, S.Luca Hospital, Istituto Auxologico Italiano, Milano, Italy. 13. ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy. 14. UOC Cardiologia Ospedale S. Spirito, Roma, Italy. 15. Department of Medical Sciences, Cardiology, IRCCS San Donato Hospital, University of Milan, San Donato Milanese, Italy. 16. Section of Cardiology, Department of Medicine, University of Verona, Italy. 17. Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. 18. Cardiovascular Center, Health Authority no. 1, Trieste, Italy. 19. Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Institute of Milan, Milan, Italy. 20. Cardiologic Department 'A. De Gasperis', Ospedale Cà Granda-A.O. Niguarda, Milano, Italy. 21. Department of Cardiology, University of Foggia, Foggia, Italy. 22. IRCCS SDN Istituto di Ricerca, Napoli, Italy. 23. Gabriele Monasterio Foundation, CNR-Regione Toscana, Pisa, Italy. 24. Scuola Superiore S. Anna, Pisa, Italy. 25. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
Abstract
AIMS: Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HF patients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF. METHODS AND RESULTS: A total of 4623 systolic HF patients (LVEF 31.5 ± 9.5%, BMI 26.2 ± 3.6 kg/m(2) ) were recruited and prospectively followed in 24 Italian HF centres belonging to the MECKI Score Research Group. Besides full clinical examination, patients underwent maximal cardiopulmonary exercise test at study enrolment. Median follow-up was 1113 (553-1803) days. The study population was divided according to BMI (<25, 25-30, >30 to ≤35 kg/m(2) ) and predicted peak oxygen consumption (peak VO2 , <50%, 50-80%, >80%). Study endpoints were all-cause and cardiovascular deaths including urgent cardiac transplant. All-cause and cardiovascular deaths occurred in 951 (28.6%, 57.4 per person-years) and 802 cases (17.4%, 48.4 per 1000 person-years), respectively. In the high BMI groups, several prognostic parameters presented better values [LVEF, peak VO2 , ventilation/carbon dioxide slope, renal function, and haemoglobin (P < 0.01)] compared with the lower BMI groups. Both BMI and peak VO2 were significant positive predictors of longer survival: both higher BMI and peak VO2 groups showed lower mortality (P < 0.001). At multivariable analysis and using a matching procedure (age, gender, LVEF, and peak VO2 ), the protective role of BMI disappeared. CONCLUSION: Exercise tolerance affects the relationship between BMI and survival. Cardiorespiratory fitness mitigates the obesity paradox observed in HF patients.
AIMS: Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HFpatients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF. METHODS AND RESULTS: A total of 4623 systolic HFpatients (LVEF 31.5 ± 9.5%, BMI 26.2 ± 3.6 kg/m(2) ) were recruited and prospectively followed in 24 Italian HF centres belonging to the MECKI Score Research Group. Besides full clinical examination, patients underwent maximal cardiopulmonary exercise test at study enrolment. Median follow-up was 1113 (553-1803) days. The study population was divided according to BMI (<25, 25-30, >30 to ≤35 kg/m(2) ) and predicted peak oxygen consumption (peak VO2 , <50%, 50-80%, >80%). Study endpoints were all-cause and cardiovascular deaths including urgent cardiac transplant. All-cause and cardiovascular deaths occurred in 951 (28.6%, 57.4 per person-years) and 802 cases (17.4%, 48.4 per 1000 person-years), respectively. In the high BMI groups, several prognostic parameters presented better values [LVEF, peak VO2 , ventilation/carbon dioxide slope, renal function, and haemoglobin (P < 0.01)] compared with the lower BMI groups. Both BMI and peak VO2 were significant positive predictors of longer survival: both higher BMI and peak VO2 groups showed lower mortality (P < 0.001). At multivariable analysis and using a matching procedure (age, gender, LVEF, and peak VO2 ), the protective role of BMI disappeared. CONCLUSION: Exercise tolerance affects the relationship between BMI and survival. Cardiorespiratory fitness mitigates the obesity paradox observed in HF patients.
Authors: Andrew J Stewart Coats; Daniel E Forman; Mark Haykowsky; Dalane W Kitzman; Amy McNeil; Tavis S Campbell; Ross Arena Journal: Nat Rev Cardiol Date: 2017-05-18 Impact factor: 32.419
Authors: Catarina Magalhães Porto; Vanessa De Lima Silva; João Soares Brito da Luz; Brivaldo Markman Filho; Vera Magalhães da Silveira Journal: ESC Heart Fail Date: 2017-08-17
Authors: Imre Csige; Dóra Ujvárosy; Zoltán Szabó; István Lőrincz; György Paragh; Mariann Harangi; Sándor Somodi Journal: J Diabetes Res Date: 2018-11-04 Impact factor: 4.011