TY - JOUR
T1 - Impact of cardiorespiratory fitness on the obesity paradox in patients with heart failure
AU - Lavie, Carl J.
AU - Cahalin, Lawrence P.
AU - Chase, Paul
AU - Myers, Jonathan
AU - Bensimhon, Daniel
AU - Peberdy, Mary Ann
AU - Ashley, Euan
AU - West, Erin
AU - Forman, Daniel E.
AU - Guazzi, Marco
AU - Arena, Ross
PY - 2013
Y1 - 2013
N2 - Objective: To determine the impact of cardiorespiratory fitness (FIT) on survival in relation to the obesity paradox in patients with systolic heart failure (HF). Patients and Methods: We studied 2066 patients with systolic HF (body mass index [BMI] gt;18.5 kg/m2) between April 1, 1993 and May 11, 2011 (with 1784 [86%] tested after January 31, 2000) from a multicenter cardiopulmonary exercise testing database who were followed for up to 5 years (mean ± SD, 25.0±17.5 months) to determine the impact of FIT (peak oxygen consumption 2 . kg-1 . min-1) on the obesity paradox. Results: There were 212 deaths during follow-up (annual mortality, 4.5%). In patients with low FIT, annual mortality was 8.2% compared with 2.8% in those with high FIT (P2) (P=.01) variable. Continuous and dichotomous BMI expressions were not significant predictors of survival in the overall and high FIT groups after adjusting for age and sex. In patients with low FIT, progressively worse survival was noted with BMI of 30.0 or greater, 25.0 to 29.9, and 18.5 to 24.9 (log-rank, 11.7; P=.003), whereas there was no obesity paradox noted in those with high FIT (log-rank, 1.72; P=.42). Conclusion: These results indicate that FIT modifies the relationship between BMI and survival. Thus, assessing the obesity paradox in systolic HF may be misleading unless FIT is considered.
AB - Objective: To determine the impact of cardiorespiratory fitness (FIT) on survival in relation to the obesity paradox in patients with systolic heart failure (HF). Patients and Methods: We studied 2066 patients with systolic HF (body mass index [BMI] gt;18.5 kg/m2) between April 1, 1993 and May 11, 2011 (with 1784 [86%] tested after January 31, 2000) from a multicenter cardiopulmonary exercise testing database who were followed for up to 5 years (mean ± SD, 25.0±17.5 months) to determine the impact of FIT (peak oxygen consumption 2 . kg-1 . min-1) on the obesity paradox. Results: There were 212 deaths during follow-up (annual mortality, 4.5%). In patients with low FIT, annual mortality was 8.2% compared with 2.8% in those with high FIT (P2) (P=.01) variable. Continuous and dichotomous BMI expressions were not significant predictors of survival in the overall and high FIT groups after adjusting for age and sex. In patients with low FIT, progressively worse survival was noted with BMI of 30.0 or greater, 25.0 to 29.9, and 18.5 to 24.9 (log-rank, 11.7; P=.003), whereas there was no obesity paradox noted in those with high FIT (log-rank, 1.72; P=.42). Conclusion: These results indicate that FIT modifies the relationship between BMI and survival. Thus, assessing the obesity paradox in systolic HF may be misleading unless FIT is considered.
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U2 - 10.1016/j.mayocp.2012.11.020
DO - 10.1016/j.mayocp.2012.11.020
M3 - Article
C2 - 23489451
AN - SCOPUS:84873824809
VL - 88
SP - 251
EP - 258
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
SN - 0025-6196
IS - 3
ER -