Charbel Abi Khalil1, Kadhim Sulaiman2, Rajvir Singh3, Amin Jayyousi4, Nidal Asaad5, Khalid F AlHabib6, Alawi Alsheikh-Ali7, Mohammed Al-Jarallah8, Bassam Bulbanat9, Wael AlMahmeed10, Soha Dargham11, Mustafa Ridha12, Nooshin Bazargani13, Haitham Amin14, Ahmed Al-Motarreb15, Husam AlFaleh6, Abdelfatah Elasfar16, Prashanth Panduranga2, Jassim Al Suwaidi5. 1. Department of Medicine, Weill Cornell Medicine, Doha, Qatar; Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar; Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar. Electronic address: cha2022@med.cornell.edu. 2. National Heart Center, Royal Hospital, Muscat, Oman. 3. Biostatistics Section, Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar. 4. Department of Endocrinology and Diabetes, Hamad Medical Corporation, Doha, Qatar. 5. Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar. 6. Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia. 7. College of Medicine, Mohammed Bin Rashid University of Medicine and Heath Sciences Dubai, United Arab Emirates. 8. Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait. 9. Department of Medicine, Al-Amiri Hospital, Kuwait City, Kuwait. 10. Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE. 11. Department of Cardiology, Adan Hospital, Kuwait. 12. Department of Epidemiology and Global Health, Weill Cornell Medicine-Qatar, Doha, Qatar. 13. Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates. 14. Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain. 15. Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen. 16. Cardiology Department, Tanta University, Tanta, Egypt.
Abstract
BACKGROUND: A U-shaped relationship has been reported between BMI and cardiovascular events among patients with acute heart failure (AHF). We hypothesized that an obesity paradox also governs the relationship between BMI and mortality in patients with type 2 diabetes (T2D) and AHF. METHODS: We studied 3-month and 12-month mortality in patients with T2D hospitalized for AHF according to 5 BMI categories: Underweight (<20kg/m2), normal weight (referent group, 20-24.9kg/m2), overweight, (25-29.9kg/m2), obese (30-34.9kg/m2) and severely obese (≥35kg/m2), in the Gulf aCute heArt failuRe rEgistry (GULF-CARE). RESULTS: Among the 5005 participants in this cohort, 2492 (49.8%) had T2D. Underweight patients had a higher 3-month and 12-month mortality risk (OR 2.04, 95% CI [1.02-4.08]; OR 2.44, 95% CI [1.35-4.3]; respectively), compared to normal weight. Severe obesity was associated with a lower 3-month and 12-month mortality risk (OR 0.53, 95% CI [0.34-0.83]; OR 0.58, 95% CI [0.42-0.81]; respectively). After adjustment for several risk variables in 2 different models, the primary outcome was still significantly increased in underweight patients, and decreased in severely obese patients, at 3months and 12months. Further, the odds of mortality decreases with increasing BMI by 0.38 at 3months and at 0.45 at 12months in a near-linear shape (p=0.007; p=0.037; respectively). CONCLUSIONS: In this cohort of patients with AHF, BMI was inversely correlated to the risk of mortality in patients with T2D. Moreover, severe obesity was associated with less mortality risk.
BACKGROUND: A U-shaped relationship has been reported between BMI and cardiovascular events among patients with acute heart failure (AHF). We hypothesized that an obesity paradox also governs the relationship between BMI and mortality in patients with type 2 diabetes (T2D) and AHF. METHODS: We studied 3-month and 12-month mortality in patients with T2D hospitalized for AHF according to 5 BMI categories: Underweight (<20kg/m2), normal weight (referent group, 20-24.9kg/m2), overweight, (25-29.9kg/m2), obese (30-34.9kg/m2) and severely obese (≥35kg/m2), in the Gulf aCute heArt failuRe rEgistry (GULF-CARE). RESULTS: Among the 5005 participants in this cohort, 2492 (49.8%) had T2D. Underweight patients had a higher 3-month and 12-month mortality risk (OR 2.04, 95% CI [1.02-4.08]; OR 2.44, 95% CI [1.35-4.3]; respectively), compared to normal weight. Severe obesity was associated with a lower 3-month and 12-month mortality risk (OR 0.53, 95% CI [0.34-0.83]; OR 0.58, 95% CI [0.42-0.81]; respectively). After adjustment for several risk variables in 2 different models, the primary outcome was still significantly increased in underweight patients, and decreased in severely obesepatients, at 3months and 12months. Further, the odds of mortality decreases with increasing BMI by 0.38 at 3months and at 0.45 at 12months in a near-linear shape (p=0.007; p=0.037; respectively). CONCLUSIONS: In this cohort of patients with AHF, BMI was inversely correlated to the risk of mortality in patients with T2D. Moreover, severe obesity was associated with less mortality risk.
Authors: Petter Bjornstad; Julie A Lovshin; Yuliya Lytvyn; Genevieve Boulet; Leif E Lovblom; Omar N Alhuzaim; Mohammed A Farooqi; Vesta Lai; Josephine Tse; Leslie Cham; Andrej Orszag; Daniel Scarr; Alanna Weisman; Hillary A Keenan; Michael H Brent; Narinder Paul; Vera Bril; Bruce A Perkins; David Z I Cherney Journal: Diabetes Care Date: 2018-02-02 Impact factor: 19.112
Authors: Gabby Elbaz-Greener; Guy Rozen; Shemy Carasso; Merav Yarkoni; Harindra C Wijeysundera; Ronny Alcalai; Israel Gotsman; Eldad Rahamim; David Planer; Offer Amir Journal: Front Cardiovasc Med Date: 2022-04-28