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Revisiting the obesity paradox in heart failure: percent body fat as predictor of biomarkers and outcome

Session Poster Session 1

Speaker Alberto Aimo

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : A Aimo (Pisa,IT), JL Januzzi (Boston,US), G Vergaro (Pisa,IT), JN Cohn (Minneapolis,US), HP Brunner-La Rocca (Maastricht,NL), A Bayes-Genis (Barcelona,ES), J Lupon (Barcelona,ES), RA De Boer (Groningen,NL), Y Takeishi (Fukushima,JP), M Egstrup (Copenhagen,DK), HK Gaggin (Boston,US), K Eggers (Uppsala,SE), R Latini (Milan,IT), K Huber (Vienna,AT), M Emdin (Pisa,IT)

A Aimo1 , JL Januzzi2 , G Vergaro3 , JN Cohn4 , HP Brunner-La Rocca5 , A Bayes-Genis6 , J Lupon6 , RA De Boer7 , Y Takeishi8 , M Egstrup9 , HK Gaggin2 , K Eggers10 , R Latini11 , K Huber12 , M Emdin13 , 1Azienda Ospedaliero-Universitaria Pisana, Scuola di Specializzazione Malattie dell'Apparato Cardiovascolare - Pisa - Italy , 2Massachusetts General Hospital - Boston - United States of America , 3Fondazione Toscana Gabriele Monasterio - Pisa - Italy , 4University of Minnesota - Minneapolis - United States of America , 5Maastricht University Medical Centre (MUMC) - Maastricht - Netherlands (The) , 6Germans Trias i Pujol University Hospital - Badalona (Barcelona) - Spain , 7University Medical Center Groningen - Groningen - Netherlands (The) , 8Fukushima Medical University - Fukushima - Japan , 9Rigshospitalet - Copenhagen University Hospital - Copenhagen - Denmark , 10Uppsala University - Uppsala - Sweden , 11IRCCS - Istituto di Ricerche Farmacologiche Mario Negri - Milan - Italy , 12Medical University of Vienna - Vienna - Austria , 13Sant'Anna School of Advanced Studies - Pisa - Italy ,


Background: Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure (HF). It is unknown whether another anthropometric measure, percent body fat (PBF), reveals different associations with outcome and HF biomarkers (NT-proBNP, high-sensitivity troponin T [hs-TnT], soluble suppression of tumorigenesis-2 [sST2]).

Methods: In an individual patient dataset, BMI was calculated as weight(kg)/height(m)2, and PBF through the Jackson-Pollock and Gallagher equations.

Results: Out of 6468 patients (median 68 years, 78% men, 76% ischemic HF, 90% reduced EF), 24% died over 2.2 years (1.5-2.9), 17% from cardiovascular death. Underweight patients (BMI <18.5 kg/m2) had the shortest survival; prognosis improved from underweight to normal and overweight, being similar from overweight to grade III obesity. Median PBF was 26.9% (22.4-33.0%) with the Jackson-Pollock equation, and 28.0% (23.8-33.5%) with the Gallagher equation, with an extremely strong correlation (r=0.996, p<0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF (all-cause death: hazard ratio - HR 0.68, 95% confidence interval - CI 0.58-0.80, p<0.001, and HR 0.64, 95% CI 0.53-0.77, p<0.001, with the Jackson-Pollock and Gallagher equations, respectively; cardiovascular death: HR 0.76, 95% CI 0.64-0.91, p=0.003, and HR 0.73, 95% CI 0.60-0.90, p=0.003, respectively). Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP (beta coefficients: BMI -0.206, PBFJackson-Pollock -0.234, PBFGallagher -0.244; all p<0.001) and sST2 (beta coefficients: BMI -0.063, p=0.004; PBFJackson-Pollock -0.083, p=0.001; PBFGallagher -0.084, p=0.001), but not hs-TnT. In obese patients (BMI =30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome.

Conclusions: Patient prognosis improves with either BMI or PBF. Obesity, assessed with BMI or PBF, is associated with lower NT-proBNP but not hs-TnT or sST2. hs-TnT or sST2 are stronger prognostic predictors than NT-proBNP among obese patients.

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