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"Obesity Paradox" in patients with chronic heart failure and comorbidity

Session Poster Session 1

Speaker Associate Professor Elena Efremova

Congress : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session
  • FP Number : P442

Authors : EV Efremova (Ulyanovsk,RU), AM Shutov (Ulyanovsk,RU), MI Tolstyga (Ulyanovsk,RU), SA Suvorova (Ulyanovsk,RU), IV Kozlova (Ulyanovsk,RU), VN Sporova (Ulyanovsk,RU), VA Novgorodskij (Ulyanovsk,RU)

Authors:
EV Efremova1 , AM Shutov1 , MI Tolstyga2 , SA Suvorova2 , IV Kozlova1 , VN Sporova1 , VA Novgorodskij1 , 1Ulyanovsk State University - Ulyanovsk - Russian Federation , 2ULYANOVSK REGIONAL CLINICAL CENTER OF SPECIALIZED TYPES OF MEDICAL AID - Ulyanovsk - Russian Federation ,

Citation:

The improved survival in obese patients compared with patients with normal body weight (obesity paradox) has not been insufficiently studied  in  patients with chronic heart failure (CHF). The aim of this study was to investigate nutritional status of patients with CHF, depending on comorbidity.

Methods. 200  patients with CHF (130 males and 70 females, mean age was 61.5±9.6 years) were studied. CHF was defined according to ESC Guidelines for  the diagnosis and treatment of acute  and chronic heart failure, 2016.  Age-adjusted Charlson Comorbidity Index (ACCI) was estimated. The studied patients were divided into 3 groups: I group (low comorbidity) with an index = 3 scores; II group (moderate comorbidity) with an index 4-5 scores  and III group (high comorbidity)  with an index = 6 scores. Follow-up period was 12 months.

Results. Age-adjusted Charlson Comorbidity Index was 5.0±2.1 scores. Metabolic syndrome was observed in 89 (43.8%) patients, obesity with a BMI = 30 kg/m2 - 97 (48.5%), overweight - 62 (31.0%) patients with CHF. Metabolic syndrome was diagnosed more often in patients with CHF with low comorbidity compared patients with high comorbidity: 38 (71.6%) vs 24 (31.2%), resp., ?2 =19.05; PI-III=0.009. Waist circumference in CHF patients with high comorbidity was less than in patients with low comorbidity: 100.4±15.6 vs 106.8±14.5 cm, resp.,  PIII-I=0.01. Patients with CHF and low comorbidity had higher body mass index compared with patients with high comorbidity: 32.1±6.1 vs 28.9 ± 5.5 kg/m2, resp., PI-III=0.04. Relative risk of death within 12 months in patients with CHF and high comorbidity was 1.68 (95% CI 1.35 - 2.09) in comparison with patients with low comorbidity. According to the results of our study, patients with CHF and higher body mass have lower comorbidity, i.e. more favorable long-term prognosis.

Conclusions. Patients with chronic heart failure and high comorbidity have lower body mass index, higher waist circumference and a poor prognosis compared with patients with chronic heart failure and low comorbidity . This fact may be one explanation for the «obesity paradox» in patients with chronic heart failure.

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