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Waist‐to‐hip ratio and mortality in heart failure
Author(s) -
Streng Koen W.,
Voors Adriaan A.,
Hillege Hans L.,
Anker Stefan D.,
Cleland John G.,
Dickstein Kenneth,
Filippatos Gerasimos,
Metra Marco,
Ng Leong L.,
Ponikowski Piotr,
Samani Nilesh J.,
van Veldhuisen Dirk J.,
Zwinderman Aeilko H.,
Zannad Faiez,
Damman Kevin,
van der Meer Peter,
Lang Chim C.
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1244
Subject(s) - medicine , waist , hazard ratio , body mass index , heart failure , waist–hip ratio , abdominal obesity , obesity paradox , confidence interval , obesity , cardiology , diabetes mellitus , proportional hazards model , demography , endocrinology , overweight , sociology
Aims A higher body mass index (BMI) is associated with better survival in heart failure (HF) patients, also known as the obesity paradox. However, BMI does not account for body composition. We therefore analysed the association between abdominal fat, measured via waist‐to‐hip ratio (WHR), BMI and all‐cause mortality in patients with HF. Methods and results For this analysis, 1738 patients from the Scottish BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT‐CHF) validation study were included. Patients without waist and hip measurements were excluded. WHR was defined as waist circumference/hip circumference, divided into tertiles and split for sex. A linear regression of principal components from an extensive panel of biomarkers was performed to provide insight in the pathophysiology behind a higher WHR. In total, 1479 patients were included, of which 33% were female and mean age was 75 ±11 years. A higher WHR was independently associated with a higher BMI, a higher prevalence of diabetes and higher New York Heart Association functional class. There was a significant interaction between sex and WHR on its association with mortality ( P <0.001). In women, a higher WHR was associated with a higher mortality risk [hazard ratio (HR) 2.23, 95% confidence interval (CI) 1.37–3.63; P =0.001], whereas no significant association was found in men (HR 0.87, 95% CI 0.63–1.20; P = 0.409). We found a strong association between a higher WHR and elevated markers of inflammation and MAPK cascade in women, while these associations were less profound in men. Conclusions A higher WHR was associated with a higher risk of death in female but not in male HF patients. These findings challenge the obesity paradox, and suggest that fat deposition is pathophysiologically harmful and may be a target for therapy in female patients with HF.