Journal article
Body mass index and survival in people with heart failure
- Abstract:
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Aims: In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes (‘obesity paradox’), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort.
Methods: We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000-2017). We used Kaplan-Meier curves, Cox regression, and penalised splines methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.
Results: There were 47,531 participants with HF (median age 78.0 years (IQR 70-84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9-31.0)) and 25,013 (52.6%) died during follow-up. Compared to healthy weight, people with overweight (HR 0.78, 95%CI 0.75-0.81, risk difference (RD) -4.1%), obesity class I (HR 0.76, 95%CI 0.73-0.80, RD -4.5%) and class II (HR 0.76, 95%CI 0.71-0.81, RD -4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95%CI 1.45-1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p-value for interaction = 0.02). Class III obesity was associated with increased risk of all-cause mortality compared to overweight (HR 1.23, 95%CI 1.17-1.29).
Conclusion: The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.1MB, Terms of use)
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- Publisher copy:
- 10.1136/heartjnl-2023-322459
Authors
- Publisher:
- BMJ Publishing Group
- Journal:
- Heart More from this journal
- Volume:
- 109
- Issue:
- 20
- Pages:
- 1542-1549
- Publication date:
- 2023-06-08
- Acceptance date:
- 2023-05-18
- DOI:
- EISSN:
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1468-201X
- ISSN:
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1355-6037
- Language:
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English
- Keywords:
- Pubs id:
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1343540
- Local pid:
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pubs:1343540
- Deposit date:
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2023-05-22
Terms of use
- Copyright holder:
- Jones et al
- Copyright date:
- 2023
- Rights statement:
- © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
- Licence:
- CC Attribution (CC BY)
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