Although obesity increases the development of HF, being overweight or obese compared with normal weight is associated with survival advantages in chronic HF patients [1]. This phenomenon is known as the obesity paradox. With this in mind, Dr Nuno Melo (Centro Hospitalar e Universitário de São João, Portugal) and his colleagues were interested in the impact of weight changes in HF patients [2]. They conducted a retrospective cohort study including 589 adult patients who were all treated in an HF clinic between January 2012 and May 2018. The study assessed their mortality risk in association with body weight trajectories.
The study participants had a reduced ejection fraction of <40% and they were followed over a median of 49 months. Study subjects were stratified according to BMI into low/normal weight (BMI <25.0 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obese (BMI ≥30 kg/m2). Subgroups were formed based on the weight variations during the first year of observation: group 1 had gained over 5% body weight, group 2 lost more than 5%, and group 3 remained stable.
The mean age of the study cohort was 69 years, 30.2% of the patients were women, and 41.8% of the cohort suffered from ischaemic heart disease. The low/normal weight category comprised 37% of included patients, 37.7% were overweight, and 25.3% were obese. Most patients were NYHA class I (40.1%) or II (45.5%). The vast majority (88.6%) received treatment with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. Over half of the patients remained stable in their weight, but 25.1% gained >5% and 16.5% lost over 5% body weight in the first 12 months. During follow-up time, 248 deaths occurred.
“Patients who lost more than 5% of their weight presented a higher death risk than those with weight gain or weight stability. An association between weight loss over 5% and worse survival persisted in overweight and low/normal-weight patients but not in the obese subgroup,” Dr Melo explained the results. A Cox regression that adjusted for factors like age, sex, and comorbidities, revealed a significantly increased hazard ratio for mortality in case of >5% weight loss only for the low/normal (HR 1.63) and overweight group (HR 1.86). “However, in the initial subgroup of obese, a weight loss of over 5% was not prognostically associated,” Dr Melo stressed. According to his conclusion, weight loss in obese HF patients should not be discouraged.
- Horwich TB, et al. Prog Cardiovasc Dis. 2018;61(2):151–56.
- Melo N, et al. Influence of weight variation in long-term mortality of heart failure patients. P60523, Heart Failure and World Congress on Acute Heart Failure 2021, 29 June–1 July.
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Table of Contents: HFA 2021
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Inconclusive results for dapagliflozin treatment in heart failure
Late-Breaking Trials
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Novel mineralocorticoid receptor antagonist effective irrespective of HF history
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Omecamtiv mecarbil might be less effective in patients with atrial fibrillation or flutter
Vericiguat effective irrespective of atrial fibrillation status
Baroreflex activation: a novel option to improve heart failure symptoms
Beta-blocker withdrawal to enhance exercise capacity in heart failure?
Inconclusive results for dapagliflozin treatment in heart failure
Computerised cognitive training improves cognitive function in HF patients
COVID-19 and the Heart
COVID-19-related HF: from systemic infection to cardiac inflammation
Myocardial infarction outcomes were significantly affected by the pandemic
TAPSE effective biomarker associated with high-risk of severe COVID-19
COVID-19 in AF patients with HF: no higher mortality but longer hospital stay
Cancer and the Heart
Heart failure patients might be at an increased risk for head and neck cancer
Trastuzumab associated with cardiotoxicity in breast cancer
Heart Failure Prevention and HRQoL in the 21st century
Psychoactive substances put young people at risk of cardiovascular disease
The challenge of improving the quality of life of heart failure patients
SGLT2 Inhibitors in Heart Failure
Empagliflozin linked to lower cardiovascular risk and renal events in real-world study
Efficacy of dapagliflozin and empagliflozin not influenced by diabetes status
Biomarker panel predicts SGLT2 inhibitor response
Best of the Posters
Real-world study suggests sacubitril/valsartan benefits elderly patients with HF
Proenkephalin: A useful biomarker for new-onset heart failure?
Weight loss associated with increased mortality risk in heart failure patients
Echocardiographic parameters linked to dementia diagnosis
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