American Heart Journal
Volume 153, Issue 1 , Pages 74-81 , January 2007

An obesity paradox in acute heart failure: Analysis of body mass index and inhospital mortality for 108927 patients in the Acute Decompensated Heart Failure National Registry

  • Gregg C. Fonarow, MD

      Affiliations

    • Ahmanson/University of California–Los Angeles Cardiomyopathy Center, University of California–Los Angeles Medical Center, Los Angeles, CA
    • Corresponding Author InformationReprint requests: Gregg C. Fonarow, MD, Ahmanson/University of California–Los Angeles Cardiomyopathy Center, University of California–Los Angeles Medical Center, 47-123 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095.
  • ,
  • Preethi Srikanthan, MD

      Affiliations

    • Ahmanson/University of California–Los Angeles Cardiomyopathy Center, University of California–Los Angeles Medical Center, Los Angeles, CA
  • ,
  • Maria Rosa Costanzo, MD

      Affiliations

    • Midwest Heart Specialists, Naperville, IL
  • ,
  • Guillermo B. Cintron, MD

      Affiliations

    • Division of Cardiovascular Disease, University of South Florida College of Medicine, Tampa, FL
  • ,
  • Margarita Lopatin, MS

      Affiliations

    • Department of Biostatistics, Scios, Inc, Fremont, CA
  • ,
  • for the ADHERE Scientific Advisory Committee and Investigators

Received 11 May 2006 ,Accepted 20 September 2006.

References 

  1. Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341:1097–1105
  2. Chen YT, Vaccarino V, Williams CS, et al. Risk factors for heart failure in the elderly: a prospective community-based study. Am J Med. 1999;106:605–612
  3. He J, Ogden LG, Bazzano LA, et al. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med. 2001;161:996–1002
  4. Wilhelmsen L, Rosengren A, Eriksson H, et al. Heart failure in the general population of men—morbidity, risk factors and prognosis. J Intern Med. 2001;249:253–261
  5. Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–313
  6. Stamler R, Stamler J, Riedlinger WF, et al. Weight and blood pressure. Findings in hypertension screening of 1 million Americans. JAMA. 1978;240:1607–1610
  7. Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321:225–236
  8. de Simone G, Devereux RB, Roman MJ, et al. Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults. Hypertension. 1994;23:600–606
  9. Vasan RS, Sullivan LM, Roubenoff R, et al. Inflammatory markers and risk of heart failure in elderly subjects without prior myocardial infarction: the Framingham Heart Study. Circulation. 2004;107:1486–1491
  10. Adelman RD. Obesity and renal disease. Curr Opin Nephrol Hypertens. 2002;11:331–335
  11. Horwich TB, Fonarow GC, Hamilton MA, et al. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol. 2001;38:789–795
  12. Lavie CJ, Osman AF, Milani RV, et al. Body composition and prognosis in chronic systolic heart failure: the obesity paradox. Am J Cardiol. 2003;91:891–894
  13. Lissin LW, Gauri AJ, Froelicher VF, et al. The prognostic value of body mass index and standard exercise testing in male veterans with congestive heart failure. J Card Fail. 2002;8:206–215
  14. Davos CH, Doehner W, Rauchhaus M, et al. Body mass and survival in patients with chronic heart failure without cachexia: the importance of obesity. J Card Fail. 2003;9:29–35
  15. Curtis JP, Selter JG, Wang Y, et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med. 2005;165:55–61
  16. Adams KF, Fonarow GC, Emerman CE, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149:209–216
  17. Fonarow GC, Adams KF, Abraham WT, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293:572–580
  18. Abraham WT, Adams KF, Fonarow GC, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005;46:57–64
  19. Mustafa I, Leverve X. Metabolic and nutritional disorders in cardiac cachexia. Nutrition. 2001;17:756–760
  20. Anker SD, Coats AJ. Cardiac cachexia: a syndrome with impaired survival and immune and neuroendocrine activation. Chest. 1999;115:836–847
  21. Rauchhaus M, Coats AJ, Anker SD. The endotoxin-lipoprotein hypothesis. Lancet. 2000;356:930–933
  22. Kistorp C, Faber J, Galatius S, et al. Plasma adiponectin, body mass index, and mortality in patients with chronic heart failure. Circulation. 2005;112:1756–1762
  23. Weber MA, Neutel JM, Smith DH. Contrasting clinical properties and exercise responses in obese and lean hypertensive patients. J Am Coll Cardiol. 2001;37:169–174
  24. Eisenstein EL, McGuire DK, Bhapkar MV, et al. Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes. Am J Med. 2005;118:981–990
  25. Kennedy LM, Dickstein K, Anker SD, et al. The prognostic importance of body mass index after complicated myocardial infarction. J Am Coll Cardiol. 2005;45:156–158
  26. Jin R, Grunkemeier GL, Furnary AP, et al. Is obesity a risk factor for mortality in coronary artery bypass surgery?. Circulation. 2005;111:3359–3365
  27. Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox?. J Am Coll Cardiol. 2002;39:578–584
  28. Kalantar-Zadeh K, Block G, Horwich T, et al. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol. 2004;43:1439–1444
  29. Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Circulation. 2006;113:898–918

 The Acute Decompensated Heart Failure National Registry and this study were funded by Scios, Inc (Freemont, CA).

PII: S0002-8703(06)00827-1

doi: 10.1016/j.ahj.2006.09.007

American Heart Journal
Volume 153, Issue 1 , Pages 74-81 , January 2007