Objective:
To investigate the relationship of body mass index (BMI) with total mortality, cardiac mortality and risk of hospitalization in patients with chronic heart failure (HF).
Methods:
A systematic search of studies published between 1966 to January 31, 2014 was conducted using Pub Med, CINAHL, Cochrane CENTRAL and the Web of Science databases. Studies reporting rate of total mortality, cardiac mortality and risk of hospitalization in patients with HF in various BMI categories [<20 kg/m2 (low); 20-24.9 kg/m2 (normal reference); 25-29.9 kg/m2 (overweight); 30-34.9 kg/m2 (obese); >=35 kg/m2 (severely obese)] were identified. Event rates were compared using a forest plot of relative risk using a random effects model assuming inter-study heterogeneity.
Results:
Two study authors independently reviewed the 124 articles and identified 6 for final analyses (N=22807). After mean follow up of 2.85 years, the risk of total mortality, cardiovascular (CV) mortality and of hospitalization was highest among patients with low BMI (RR 1.27 [95% CI 1.17 - 1.37]; 1.20 [95% CI 1.01 -1.43]; 1.19 [95% CI 1.09 - 1.30] respectively). Risk of cardiac mortality and hospitalization was lowest in overweight patients (RR0.79 [95% CI 0.70-0.90] and 0.92 [95% CI 0.86-0.97] respectively). Increasing degree of obesity failed to achieve a statistically significant effect on CV mortality (0.82 [0.64-1.05] and 0.71 [0.50-1.01] for obese and severely obese, respectively) and on hospitalization (0.99 [0.92-1.07] and 1.28 [0.88-1.87] for obese and severely obese, respectively)
Conclusion:
Risk of total mortality, cardiac mortality and hospitalization was highest among chronic HF patients who were underweight as defined by low BMI, whereas risk of cardiac mortality and hospitalization was lowest in the overweight. Further prospective studies are needed to investigate this association and apparent “overweight paradox” and explore potential underlying mechanisms for this association.
ASSOCIATIONS OF BODY MASS INDEX, WASTING SYNDROME AND PROGNOSIS IN PATIENTS WITH CHRONIC HEART FAILURE
