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Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus: a propensity‐matched study
Author(s) -
Adamopoulos Chris,
Meyer Philippe,
Desai Ravi V.,
Karatzidou Kyparissi,
Ovalle Fernando,
White Michel,
Aban Inmaculada,
Love Thomas E.,
Deedwania Prakash,
Anker Stefan D.,
Ahmed Ali
Publication year - 2011
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 - 10.1093/eurjhf/hfq159
Subject(s) - medicine , obesity , hazard ratio , heart failure , diabetes mellitus , body mass index , obesity paradox , confidence interval , propensity score matching , endocrinology , overweight
Aims Obesity is paradoxically associated with survival benefit in patients with chronic heart failure (HF). However, obesity complicates the management of diabetes mellitus (DM), which is common in HF. Yet, little is known about the impact of obesity in HF patients with DM. Therefore, we examined the association between obesity and outcomes in propensity‐matched cohorts of HF patient with and without DM. Methods and results Of the 7788 participants with chronic mild to moderate HF in the Digitalis Investigation Group trial, 7379 were non‐cachectic [body mass index (BMI) ≥20 kg/m 2 ] at baseline. Of these, 2153 (29%) had DM, of whom 798 (37%) were obese (BMI ≥30 kg/m 2 ). Of the 5226 patients without DM, 1162 (22%) were obese. Propensity scores for obesity were used to separately assemble 636 pairs of obese and non‐obese patients with DM and 770 pairs of obese and non‐obese patients without DM, who were balanced on 32 baseline characteristics. Among matched patients with DM, all‐cause mortality occurred in 38 and 39% of obese and non‐obese patients, respectively [hazard ratio (HR) when obesity was compared with no obesity 0.99; 95% confidence interval (CI) 0.80–1.22; P = 0.915]. Among matched patients without DM, all‐cause mortality occurred in 23 and 27% obese and non‐obese patients, respectively (HR associated with obesity 0.77; 95% CI 0.61–0.97; P = 0.025). Conclusion In patients with chronic mild to moderate HF and DM, obesity confers no paradoxical survival benefit. Whether intentional weight loss may improve outcomes in these patients needs to be investigated in future prospective studies.