Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus: A propensity-matched study

Chris Adamopoulos, Philippe Meyer, Ravi V. Desai, Kyparissi Karatzidou, Fernando Ovalle, Michel White, Inmaculada Aban, Thomas E. Love, Prakash Deedwania, Stefan D. Anker, Ali Ahmed

Research output: Contribution to journalArticle

Abstract

Aims Obesity is paradoxically associated with survival benefit in patients with chronic heart failure (HF). However, obesity complicates the management of diabetes mellitus (DM), which is common in HF. Yet, little is known about the impact of obesity in HF patients with DM. Therefore, we examined the association between obesity and outcomes in propensity-matched cohorts of HF patient with and without DM. Methods and results Of the 7788 participants with chronic mild to moderate HF in the Digitalis Investigation Group trial, 7379 were non-cachectic [body mass index (BMI) ≤20 kg/m2] at baseline. Of these, 2153 (29%) had DM, of whom 798 (37) were obese (BMI 2). Of the 5226 patients without DM, 1162 (22%) were obese. Propensity scores for obesity were used to separately assemble 636 pairs of obese and non-obese patients with DM and 770 pairs of obese and non-obese patients without DM, who were balanced on 32 baseline characteristics. Among matched patients with DM, all-cause mortality occurred in 38 and 39 of obese and non-obese patients, respectively [hazard ratio (HR) when obesity was compared with no obesity 0.99; 95% confidence interval (CI) 0.801.22; P = 0.915]. Among matched patients without DM, all-cause mortality occurred in 23 and 27% obese and non-obese patients, respectively (HR associated with obesity 0.77; 95% CI 0.61-0.97; P = 0.025). ConclusionIn patients with chronic mild to moderate HF and DM, obesity confers no paradoxical survival benefit. Whether intentional weight loss may improve outcomes in these patients needs to be investigated in future prospective studies.

Original languageEnglish
Pages (from-to)200-206
Number of pages7
JournalEuropean Journal of Heart Failure
Volume13
Issue number2
DOIs
Publication statusPublished - Feb 2011

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Diabetes Mellitus
Heart Failure
Obesity
Body Mass Index
Confidence Intervals
Propensity Score
Survival
Mortality
Digitalis
Weight Loss
Prospective Studies

Keywords

  • Diabetes
  • Heart failure
  • Hospitalization
  • Mortality
  • Obesity
  • Propensity score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus : A propensity-matched study. / Adamopoulos, Chris; Meyer, Philippe; Desai, Ravi V.; Karatzidou, Kyparissi; Ovalle, Fernando; White, Michel; Aban, Inmaculada; Love, Thomas E.; Deedwania, Prakash; Anker, Stefan D.; Ahmed, Ali.

In: European Journal of Heart Failure, Vol. 13, No. 2, 02.2011, p. 200-206.

Research output: Contribution to journalArticle

Adamopoulos, C, Meyer, P, Desai, RV, Karatzidou, K, Ovalle, F, White, M, Aban, I, Love, TE, Deedwania, P, Anker, SD & Ahmed, A 2011, 'Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus: A propensity-matched study', European Journal of Heart Failure, vol. 13, no. 2, pp. 200-206. https://doi.org/10.1093/eurjhf/hfq159
Adamopoulos, Chris ; Meyer, Philippe ; Desai, Ravi V. ; Karatzidou, Kyparissi ; Ovalle, Fernando ; White, Michel ; Aban, Inmaculada ; Love, Thomas E. ; Deedwania, Prakash ; Anker, Stefan D. ; Ahmed, Ali. / Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus : A propensity-matched study. In: European Journal of Heart Failure. 2011 ; Vol. 13, No. 2. pp. 200-206.
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T1 - Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus

T2 - A propensity-matched study

AU - Adamopoulos, Chris

AU - Meyer, Philippe

AU - Desai, Ravi V.

AU - Karatzidou, Kyparissi

AU - Ovalle, Fernando

AU - White, Michel

AU - Aban, Inmaculada

AU - Love, Thomas E.

AU - Deedwania, Prakash

AU - Anker, Stefan D.

AU - Ahmed, Ali

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N2 - Aims Obesity is paradoxically associated with survival benefit in patients with chronic heart failure (HF). However, obesity complicates the management of diabetes mellitus (DM), which is common in HF. Yet, little is known about the impact of obesity in HF patients with DM. Therefore, we examined the association between obesity and outcomes in propensity-matched cohorts of HF patient with and without DM. Methods and results Of the 7788 participants with chronic mild to moderate HF in the Digitalis Investigation Group trial, 7379 were non-cachectic [body mass index (BMI) ≤20 kg/m2] at baseline. Of these, 2153 (29%) had DM, of whom 798 (37) were obese (BMI 2). Of the 5226 patients without DM, 1162 (22%) were obese. Propensity scores for obesity were used to separately assemble 636 pairs of obese and non-obese patients with DM and 770 pairs of obese and non-obese patients without DM, who were balanced on 32 baseline characteristics. Among matched patients with DM, all-cause mortality occurred in 38 and 39 of obese and non-obese patients, respectively [hazard ratio (HR) when obesity was compared with no obesity 0.99; 95% confidence interval (CI) 0.801.22; P = 0.915]. Among matched patients without DM, all-cause mortality occurred in 23 and 27% obese and non-obese patients, respectively (HR associated with obesity 0.77; 95% CI 0.61-0.97; P = 0.025). ConclusionIn patients with chronic mild to moderate HF and DM, obesity confers no paradoxical survival benefit. Whether intentional weight loss may improve outcomes in these patients needs to be investigated in future prospective studies.

AB - Aims Obesity is paradoxically associated with survival benefit in patients with chronic heart failure (HF). However, obesity complicates the management of diabetes mellitus (DM), which is common in HF. Yet, little is known about the impact of obesity in HF patients with DM. Therefore, we examined the association between obesity and outcomes in propensity-matched cohorts of HF patient with and without DM. Methods and results Of the 7788 participants with chronic mild to moderate HF in the Digitalis Investigation Group trial, 7379 were non-cachectic [body mass index (BMI) ≤20 kg/m2] at baseline. Of these, 2153 (29%) had DM, of whom 798 (37) were obese (BMI 2). Of the 5226 patients without DM, 1162 (22%) were obese. Propensity scores for obesity were used to separately assemble 636 pairs of obese and non-obese patients with DM and 770 pairs of obese and non-obese patients without DM, who were balanced on 32 baseline characteristics. Among matched patients with DM, all-cause mortality occurred in 38 and 39 of obese and non-obese patients, respectively [hazard ratio (HR) when obesity was compared with no obesity 0.99; 95% confidence interval (CI) 0.801.22; P = 0.915]. Among matched patients without DM, all-cause mortality occurred in 23 and 27% obese and non-obese patients, respectively (HR associated with obesity 0.77; 95% CI 0.61-0.97; P = 0.025). ConclusionIn patients with chronic mild to moderate HF and DM, obesity confers no paradoxical survival benefit. Whether intentional weight loss may improve outcomes in these patients needs to be investigated in future prospective studies.

KW - Diabetes

KW - Heart failure

KW - Hospitalization

KW - Mortality

KW - Obesity

KW - Propensity score

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