Weight loss associated with increased mortality risk in heart failure patients

A retrospective study examined the impact of changes in weight on all-cause mortality of patients with heart failure (HF). More than 5% body weight loss over 1 year was associated with an increased likelihood of mortality in initially normal or overweight but not in obese patients.

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.

 

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   1. Horwich TB, et al. Prog Cardiovasc Dis. 2018;61(2):151–56.
   2. 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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Posted on 19 August, 202120 August, 2021