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Revisiting the obesity paradox in heart failure: Per cent body fat as predictor of biomarkers and outcome
Univ Hosp Pisa, Cardiol Div, Pisa, Italy.
Massachusetts Gen Hosp, Boston, MA 02114 USA;Baim Inst Clin Res, Boston, MA USA.
Scuola Super Sant Anna, Inst Life Sci, Pisa, Italy;Fdn Toscana G Monasterio, Pisa, Italy.
Scuola Super Sant Anna, Inst Life Sci, Pisa, Italy;Fdn Toscana G Monasterio, Pisa, Italy.
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2019 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 26, no 16, p. 1751-1759Article in journal (Refereed) Published
Abstract [en]

Aims Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)). Methods In an individual patient dataset, BMI was calculated as weight (kg)/height (m) (2) , and PBF through the Jackson-Pollock and Gallagher equations. Results Out of 6468 patients (median 68 years, 78% men, 76% ischaemic heart failure, 90% reduced ejection fraction), 24% died over 2.2 years (1.5-2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4-33.0%) with the Jackson-Pollock equation, and 28.0% (23.8-33.5%) with the Gallagher equation, with an extremely strong correlation (r = 0.996, p < 0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI >= 30 kg/m(2), third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome. Conclusion In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.

Place, publisher, year, edition, pages
Sage Publications, 2019. Vol. 26, no 16, p. 1751-1759
Keywords [en]
Obesity, heart failure, natriuretic peptides, troponin, sST2, prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-398721DOI: 10.1177/2047487319852809ISI: 000485371800001PubMedID: 31154828OAI: oai:DiVA.org:uu-398721DiVA, id: diva2:1376985
Available from: 2019-12-10 Created: 2019-12-10 Last updated: 2020-01-07Bibliographically approved

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Eggers, Kai M.

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